General Authorization Letter
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3GENERAL AUTHORIZATION LETTER
Please type or print
SM
Dear LegalShield
member:
You requested that we write a letter or make a telephone call to an opposing party on your
behalf. In order for us to do so, please carefully read this letter and the Request For Letter or
Telephone Call that follows, then complete the requested information, sign the form and return it
to us. YOU MUST FULLY COMPLETE EACH BLANK LINE AND PROVIDE ALL
REQUESTED INFORMATION BEFORE WE CAN CONTACT THE OPPOSING
PARTY ON YOUR BEHALF.
Sincerely yours,
Framme Law Firm PC
Request for Letter or Telephone Call
Date:
To: Framme Law Firm, PC
Attention/ Attorney:
Email: - or- Fax #:
All attorneys have direct fax numbers; please fax to the number given to you by the attorney.
I f you have trouble with that number, you can fax to our firm’s main fax number (800) 930-3150.
You can always mail the documents via regular mail.
From:
Intake #:
LegalShield Membership #:
My Mailing Address:
I have discussed my legal matter with you and request that you send a letter or make a telephone
call to an opposing party on my behalf. This request is also my authorization for you to do so in
accordance with my consultation with you and based on the information contained below.
I understand that if this request involves review of my personal health information and is subject
to the Federal Health Insurance Portability and Accountability Act (Health Information Privacy
Rule), I hereby authorize Framme Law Firm, PC to obtain and release this information as
appropriate or helpful to comply with this request.
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Parent category: Letters