[Your Name]
[Your Address]
[Your City, State, ZIP Code]
[Your Phone Number]
[Your Email Address]
[Date]
[Recipient's Name]
[Recipient's Position]
[Recipient's Organization]
[Recipient's Address]
[Recipient's City, State, ZIP Code]
RE: Request for Service Dog Accommodation for [Disabled Person's Name]
Dear [Recipient's Name],
I am writing to request reasonable accommodation under the Americans with Disabilities Act (ADA) on behalf of my patient, [Disabled Person's Name], a resident of [City, State]. [Disabled Person's Name] has been diagnosed with [Disability] and uses a service dog named [Service Dog's Name] as an assistive device to mitigate the substantial limitations caused by their disability.
[Disabled Person's Name] has been my patient for [number] years, and I have monitored their medical condition and progress closely. [Disability] severely restricts [Disabled Person's Name]'s ability to perform essential activities of daily living without the assistance of a service dog. Specifically, [Disability] impairs [Disabled Person's Name]'s mobility, balance, and ability to retrieve objects.
[Service Dog's Name] has been specially trained to assist [Disabled Person's Name] with tasks such as:
- Retrieving objects
- Opening and closing doors
- Providing stability and balance
- Assisting with navigation and wayfinding
- Alerting to potential dangers
The presence of [Service Dog's Name] is crucial to [Disabled Person's Name]'s independence and safety, allowing them to participate fully in public life. Therefore, I respectfully request that you provide reasonable accommodation by allowing [Service Dog's Name] to accompany [Disabled Person's Name] in all public areas of [Recipient's Organization]. This accommodation falls under the ADA guidelines of "reasonable modifications" and "auxiliary aids and services" to facilitate equal enjoyment of goods, services, and facilities by individuals with disabilities.
To protect the health and privacy of both [Disabled Person's Name] and [Service Dog's Name], I am enclosing copies of the following documents:
- [Disabled Person's Name]'s medical records relevant to their disability
- [Service Dog's Name]'s training certification
- Proof of the service dog's immunizations
Please note that [Service Dog's Name] is a well-behaved and unobtrusive animal who poses no threat to others. They have been trained to remain calm and under control in public settings.
I kindly request that you provide written confirmation of the accommodation for [Disabled Person's Name] and [Service Dog's Name] to the above-listed email address within 30 days of the date of this letter.
Thank you for your attention to this matter. I trust that you will recognize the importance of allowing service dogs to assist disabled individuals, and I look forward to your prompt and favorable response.
Yours sincerely,
[Your Name]
[Your Medical License or Credentials]
Enclosure:
1. Copies of [Disabled Person's Name]'s relevant medical records
2. Copy of [Service Dog's Name]'s training certification
3. Proof of [Service Dog's Name]'s immunizations
Sample 2:
[Doctor's Name]
[Doctor's Position]
[Medical Practice/Clinic Name]
[Address of Medical Practice]
[City, State, ZIP Code]
[Phone Number of Medical Practice]
[Email Address of Medical Practice]
[Date]
[Recipient's Name]
[Recipient's Position]
[Service Animal Assistance Program]
[Address of Program]
[City, State, ZIP Code]
RE: Letter of Support for Service Dog Placement for Mr./Ms. [Patient's Name]
Dear [Recipient's Position],
I hope this letter finds you in good spirits. I am writing to provide my professional support and recommendation for Mr./Ms. [Patient's Name] in acquiring a suitable service dog. As their medical provider, I am deeply committed to ensuring the well-being of my patients.
Mr./Ms. [Patient's Name] has been under my care for [Number of Years] years. They have been diagnosed with [Patient's Disability], which significantly impairs their [specific limitations of the patient]. Due to the severity of their condition, Mr./Ms. [Patient's Name] experiences severe challenges with [daily tasks or activities that the service dog would help with].
After thorough medical assessment and evaluation, it has become evident that a well-trained service dog can greatly improve Mr./Ms. [Patient's Name]'s quality of life and enable them to achieve greater independence. Service dogs are recognized by the Americans with Disabilities Act (ADA) as necessary assistive devices for individuals with disabilities. This remarkable companionship empowers people to navigate daily challenges with greater confidence and efficiency, reducing their burden and enhancing their ability to participate more actively in society.
A service dog can provide practical support to Mr./Ms. [Patient's Name] by [specific tasks the patient's service dog can assist with, such as mobility, retrieving items, or alerting to medical incidents]. This assistance has proven incredibly valuable in managing Mr./Ms. [Patient's Name]'s disability, leading to improved safety and overall health outcomes.
Given the positive impact a service dog can have on Mr./Ms. [Patient's Name]'s life, I wholeheartedly endorse their application for a service animal. I am confident that they will be a responsible and dedicated partner to their service dog, fostering a mutually beneficial relationship.
I trust that my professional recommendation will be considered favorably, and I am more than willing to provide any additional information or clarification if needed. Please feel free to contact me at [Contact Number] or [Email Address] for further inquiries.
Sincerely,
[Doctor's Name]
[Medical License Number]
[Board Certification/Specialty]
[Medical Practice Name]