CLIENT-REQUESTED LETTER SEND-OUT FORM Clinician Name(Required) First Last Clinician Gmail Enter Email Confirm Email Please use your Change, Inc. Gmail (NOT your @changeincorporated.org address)Client Name(Required) First Last Client Email(Required) Enter Email Confirm Email Date of Initial Letter Request(Required) Today's Date(Required) Upload Letter PDF here. Multiple files are allowed if necessary.(Required) Drop files here or Select files Max. file size: 32 MB. Attestation regarding Calendar/Letter Writing Fee(Required) I previously placed my time for writing this letter on the calendar and ensured that the fee has been charged by the CLT.NOTE: If you have not completed these steps, please do so before sending the letter so that you can attest appropriately. Please do not send this form/the letter without completing this step first.Attestation regarding Google Drive Upload(Required) I have uploaded the above attached PDF(s) to the appropriate client file on the Change, Inc. Google Drive Δ
