Medical Hardship Letter Template

Download this Medical Hardship Letter Template Design in Google Docs, Word, PDF, Apple Pages, Outlook Format. Easily Editable, Printable, Downloadable.

If you’re in search of support for medical issues, allow us to help you with our Free Medical Hardship Letter. Take advantage of our template’s carefully written content to express the gravity of your medical situation effectively. Additionally, this sample gives you highlighted placeholders to guide you accordingly. So, download now for Apple Pages, Google Docs, Microsoft Outlook, or Microsoft Word.

Medical Hardship Letter Template

[DATE]

Dear [RECIPIENT NAME],

I regret to inform you that I am unable to pay my bill in full at this time due to financial setbacks. Therefore, I am formally requesting a settlement for the medical bills that I owe your hospital.

I am requesting a payment plan of [NUMBER] (USD) per month until such time that I am able to go back to work, and receive my usual salary. As noted in my medical records, rehabilitation may take up to [PERIOD]. I will pay by check on the 15th of each month beginning [DATE 1].

If this proposed payment scheme is agreeable to you, please send me a letter stating the the repayment details as described. You may be able to reach me via mobile at [YOUR PHONE NUMBER] or email at [YOUR EMAIL ID]. The requested documents are enclosed in this packet as agreed.

Thank you for your consideration.

Regards,

[YOUR SIGNATURE]

[YOUR NAME]