Sample Letter (English)

(Date)

Dear Mr./Ms./Senator/Representative (Surname of Contact):

My name is (Full name of patient), aged (Age), resident of (Home address of patient). I was
diagnosed with (Diagnosis, refer to histopathology report). Treatment for this disease is
estimated at PhP (Total cost of treatment) to cover (Name of main medicines/How many times
needed).

May I ask for financial assistance to cover cost of medication, tests and treatment? I am under
the care of Dr. (Full name of doctor) of (Name of hospital and address of hospital).

Enclosed are the histopathology report, medical abstract, treatment plan and cost estimate
from my doctor.

Thank you.

(Signature and Full Name of Patient)