Sample Letter of Authorization

Send a letter of authorization to indicate that you are authorizing something or someone on a particular matter. As is the case with all letters, the style and wording you use in a letter depend on the specific circumstances. Many types of authorization letters relate to legal matters, so be sure to consult relevant laws as you write these letters. Also obtain the counsel of an attorney as needed.

Use appropriate tone in your letters, depending on your audience. For example, if you know the recipient well and are not sending a formal letter, you can use more casual tone. Most business letters call for a formal style. In general, it is best to keep letters as short and concise as possible while still communicating the relevant information.

Feel free to customize and modify any of these letters according to your individual needs.

NOTE: In all letters, brackets indicate information that you should fill in. Remove the brackets when you have modified the text to your liking.

Medical or financial information is often required by a doctor or financial institution in order to administer treatment or to finalize a transaction. In such situations, you must write an authorization letter in order to release the information. The following letter is a sample authorization letter for releasing medical records.


Your Name
Your Street Address
City, State, Zip Code

Date (MM/DD/YYY)

Any Hospital
Street Address
City, State, Zip Code

To Whom It May Concern:

I, William D. Farrow, hereby authorize [Hospital Name] to release to Aletha Snowhite, M.D., any information in my personal medical records, including all x-rays, cat scans, and any other information pertinent to my treatment while I am under the care of [Hospital Name] during the time period from May 15 to June 1, 2007. I give my permission for this medical information to be used for the following purpose: to assist in the diagnosis and treatment of my reoccurring abdominal pain. I do not, however, give permission for any other use or for any re-disclosure of this information.

Full name of Patient
Signature of Patient
Date of Signature

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