Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)

DATE

To Whom It May Concern:

My patient John Doe will be requiring four appointments to our office, each lasting approximately one and one-half hours each.  These are for necessary medical/dental treatment.

After this series of treatments, he will require at least one appointment every three months.

Please call me if you have any questions.

Sincerely,

Dr. _______
cc: PatientName