Date:______________________
Physicians name:_________________________
Physicians License Number:________________________________
To whom it may concern,
My patient ___________ is disabled as defined by the Americans With Disabilities Act, Fair Housing Act, Air Carrier Access Act, and Section 504 of the Rehabilitation Act of 1973. The use of a service dog is required in order to mitigate the symptoms of their disability.
If you have any questions please contact me at ___________ and and I will do my best to answer them within the realm of confidentiality.
Thank you,
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