Contents of the Template
This template includes several key sections designed to help you draft a clear and effective Service Dog Letter from a Doctor:
- Doctor’s Information: Details of the healthcare professional, including their full name, license number, and contact information.
- Patient Information: A table where the user can insert the patient’s full name, date of birth, ID, address, phone number, and email address.
- Medical Conditions: A section to list the patient’s diagnosed medical conditions, complete with ICD-10 codes and dates of diagnosis.
- Effect of Condition on Daily Life: A segment to explain how the patient’s condition significantly impacts their daily life.
- Recommendation for a Service Dog: Details the tasks or functions the service dog will perform for the patient.
- Additional Recommendations and Notes: Space for any specific comments regarding the patient’s need for a service dog.
- Statement of Professional Opinion: A written confirmation from the doctor about the necessity of a service dog for the patient’s treatment.
- Verification: A section where the doctor provides consent to be contacted for verification purposes.
- Doctor’s Signature and Official Stamp/Seal: Space for the healthcare professional’s signature and official stamp/seal, confirming the document’s authenticity.
Why Use This Template
- Efficiency and Clarity: This template is designed to be straightforward, making it easy for healthcare professionals to clearly articulate a patient’s need for a service dog.
- Customizable: Available in Word, PDF, and Google Docs formats, this template is easy to edit and tailor to specific patient needs.
- Professional Layout: The structured format ensures that the letter appears professional and contains all necessary components, potentially speeding up the approval process for a service dog.
- Legal and Medical Compliance: The template is designed to align with common legal and medical standards, but should be cross-checked with current local regulations.
- Healthcare Professionals: Doctors, psychologists, and other healthcare providers who need to prescribe a service dog for a patient with a qualifying disability.
- Patients: Individuals seeking a clear and professional way to present their need for a service dog to landlords, employers, or other entities.
- Legal and Advocacy Groups: Organizations assisting individuals with disabilities in securing accommodations, including the use of service animals.
- Educational Institutions and Workplaces: When a student or employee needs to request accommodations to bring a service dog to a school or workplace environment.