HTML Preview Sample Request Letter For Doctor Appointment page number 1.
Bruce M. McCormack, M.D. & E. Fletcher Eyster, M.D.
2320 Sutter Street, Second Floor Suite 202
415-923-9222 Fax 415-923-9255
Dear
This letter confirms your appointment with Dr. Bruce M. McCormack or Dr. Edward
Fletcher Eyster on _____/_____/_____ at _________. Our office is located at 2320
Sutter St., Suite 202, between Scott and Divisadero. Unfortunately, we do not validate
parking. Parking garage is at Mt. Zion Hospital on Sutter Street cross Divisadero Street.
The following checklist contains all information needed to provide a complete
evaluation:
*An authorization or referral form from your primary physician, if required by your
insurance carrier must be delivered or faxed to our office prior to visit. If your insurance
is Workers Compensation, an authorization must be obtained through your case
manager/adjuster. Please pull ALL WC information requested, on the forms
provided.
*All X-ray films, CT – scans, MRI, etc. must be within the past 6 months to be
considered for review. It is CRITICAL THAT YOU HAND CARRY YOUR FILMS
& WRITTEN REPORT TO OUR OFFICE. (Do not have them sent via mail or fed-
x. If you do not have films, we will reschedule your appointment.
*Bring insurance cards, if applicable. If you are self-paying or have a co-pay, please
bring exact change. You may pay by cash, check, or credit card.
*We have enclosed a health questionnaire to be filled out completely and hand carried to
the office. It is important that you provide ALL physician information, requested on the
forms: Full Name, Address, and current Telephone Number. Dr. McCormack will
send reports to all doctors listed on the form.
Please be advised that Dr. McCormack & Dr. Eyster could be called into surgery at any
time. In the event that this happens, we will have to reschedule your appointment date.
Sorry for any future inconveniences.
If you have any questions, please call us at 415-923-9222.
Thank You