Patient letters

Pick the letter that fits, fill in the blanks, then copy or download it. Everything stays on your device — nothing you type is sent or saved. These are templates, not legal advice.

Not sure which letter you need? See the Patient Letter Hub. Appealing an insurance denial? Use the appeal letter builder. Asking for charity care? Use the financial assistance letter.

Debt validation request

Law:: Fair Debt Collection Practices Act, 15 U.S.C. §1692g
Timing:: Send within 30 days of the collector’s first written notice. Collection must pause until they respond.
Send to:: The collection agency (certified mail, return receipt).

Your letter

[Your name]
[Your address]

[Date]

[Recipient name and address]

Re: Request for validation of debt
Account/Reference: [Account number]

I am writing in response to your notice about a debt of [amount]. Under 15 U.S.C. §1692g(b), I dispute this debt and request validation.

Please provide:
1. The name of the original creditor (provider) and the dates of service.
2. An itemized statement showing how the amount was calculated, including insurance payments and adjustments.
3. Proof that you are licensed to collect in my state and are authorized to collect this account.

Please stop collection activity, and do not report this account to a credit bureau as undisputed, until you have provided this information.
Sincerely,

[Your name]

Keep a copy and send by certified mail with return receipt when you can. Replace anything in [brackets] before sending.