Medical Authorization Letter

If you would like to authorize a hospital to share your medical history, you can use this Medical Authorization Letter to give consent.

[Sender’s Name]

[City, State and Zip Code]

[Mobile Number]


[Recipient’s Name]

[Hospital’s Name]

[City, State and Zip Code]

[Email Address]

To Whom It May Concern,

I [Sender’s Name] would like to express consent to [Hospital’s Name] to provide all my medical information to all authorized parties. I have been [Doctor’s Name] patient for [Duration] and undertaken several research studies.

I authorize the hospital o share all results from these studies. I also give my authorization for the available information to diagnose and treat whenever needed. For any clarification, you can reach out to me through my mobile number [Number].


[Sender’s Signature]

[Sender’s Name]