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If you would like to authorize someone to collect your medical results on your behalf, here is a sample authorization letter to pick up medical results.



[Your Name]

[Your Address]

[Contact Information]


[Recipient’s Name]

[Recipient’s Designation]

[Name of Medical Institute]


Subject: Authorization To Collect Medical Results On My Behalf

Please allow the medical results for my recent tests to be collected by [Name of Entrusted Person]. I have included my medical information, the tests’ payment receipt, and an attested copy of my identification.

Mentioned Below are the verification details of the authorized person.

Authorized Person’s Name: [Name of Entrusted Person]

Signature: [Signature of Entrusted Person]

Thank you for your consideration.


[Your Name]

[Your Signature]