Dr. letter to request blood test

Below is a sample letter that you can edit and fax to your Doctor requesting him/her to sign the Blood Test requisition form so you can get a free blood test.  Fill out the top section of the attached requisition form except for your dosage and the date of the test. Your Doctor fills out the middle box.  Keep a copy of the form that your Dr. signs so that you can reuse it.  If the requisition form doesn't print properly then email me and I will send you a .pdf file.  I can't figure out how to attach the .pdf to this blog.

Your name

Your address

Coppell, TX 75019

May 2, 2012

Re:  your name, DOB:  your birthdate

Dear Dr. xxxx:

I have an opportunity to get a free blood test to measure the AA/EPA ratio in my blood and help determine if I am taking the right amount of fish oil.  It is a self test, so that you do not have to do anything except sign the attached "Test Requisition Form."  A copy of the results will be sent to your office. 

Please sign the attached form, and have someone fax it to me at ######### or call me at ###### and I will pick it up. 

Respectfully,

(sign here)

Your name