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      Sample Request

      Capital Health Plan
      Provider Enrollment
      2140 Centerville Road
      Tallahassee, FL  32308

      To whom it may concern:

      I am writing to you requesting that you allow Dr. Melton to become a participating provider with Capital Health Plan.

      Dr. Cal Melton, Owner, Downtown Chiropractic and Sports Development Center, has been treating patients in Tallahassee for over 8 years.  The first 6 years were spent as partner in Grant-Melton Chiropractics and in January he opened his own facility.  I have personally been a patient of his and am also a current member of Capital Health Plan.

      I feel that Dr. Melton would be an absolute asset to the organization.  His appointment will be a determining factor in my decision when choosing a provider during open enrollment.  Please accept this letter as my recommendation that Dr. Melton be able to serve the local Capital Health Plan patients.

      Sincerely,

      Your Name
      CHP Member
      CHP Number