Printable Medical Forms
Diabetes Travel Letter Medical Form

{Physician Name}


{city, state, zip}






To whom it may concern,


My patient {Name} has {Type 1/Type 2} diabetes and it is imperative that the following devices, medications, and other listed items remain with them at all times during travel or otherwise.


{Brand} continuous glucose monitor (CGM)

Blood glucose meter, test strips, and lancets or finger-stick device

{Brand} insulin pump

{Brand} insulin

{Medication Name} medication



Glucose tablets

{other emergency items}


Please contact me at {contact} if you need further information.



{Physician Name}


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