Writing letters for clients

Some clients may request that their therapist write a letter on their behalf, often for the purpose of obtaining an emotional support animal (ESA), academic/work accommodations or for proof of engagement in treatment, as examples. Writing a letter for a client has unique ethical, legal, and liability considerations, regardless of client diagnosis, situation, or the nature of their request. As a result, the decision to write a letter is completely at the discretion of each individual therapist. Rula does not have any policy for if and when letter writing should be completed, since boundaries, scope, and preferences vary by provider. Rula also is unable to handle letter requests on behalf of the therapist, as only the treating provider is able to do so at their individual clinical discretion. 


If you do decide to write a letter for your client, here are some important considerations:


  • Keep letters brief with only the minimum information necessary
    To protect client confidentiality, it is advisable to keep the clinical content of a letter to a minimum, address the letter to the client and provide the letter directly to the client. By doing it this way, you do not need a release of information. . The letter belongs to the client and they can do what they wish with it. 


  • You can set a boundary on how long you must work with a client before you engage in letter writing
    Some clients may present for the initial assessment and immediately ask for a letter. While Rula does not have a policy on this, a clinical best practice is to to set a boundaried expectation with your client. For example, notifying the client that you would need to have a minimum of 4 sessions before you can write any letter on their behalf related to their treatment. 


  • You cannot bill commercial insurance for letter writing
    At Rula, any care coordination services (such as the time spent writing letters) is not reimbursable by commercial insurance. You have the option to either conduct this service free of charge, or could seek self-pay reimbursement from the client. To receive reimbursement directly from the client, you would need to negotiate a separate "fee schedule" in writing with the client, where they could pay you directly for those services (it would not be billed through Rula, you would collect payment independently).  Rula does not offer sample fee schedules, as this is specific to your private practice and license. For this reason, many Rula providers elect to not provide services beyond psychotherapy sessions to Rula clients, with an exception of a brief letter confirming dates of engagement in care and very limited clinical info that may be done quickly.

Letter Writing FAQ

  • What if I feel writing the requested letter is out of my scope of practice?
    We encourage you to be well-aware of your scope of practice and when a client’s needs transition out of that scope. Some specialized scope of practice situations may include: letters related to FMLA/disability, emotional support animal letters, and gender-affirming care documentation. In addition to consulting with your liability insurance, your board, and/or legal representation as needed, we also want to remind you that Rula has a large network of therapists with many different specialities. If you recognize you may not be the best provider to write a letter for a client because you do not specialize in their area of need, you should communicate that to the client and maintain that scope boundary, as well as consider options for a rematch with a therapist who specializes in the client’s area of need, if obtaining the letter is a critical element of their care.

  • If I determine that I am not able to provide a letter to my client, what other options can I give them? 
    The client could request their medical records from Rula that denote their diagnosis and symptoms and do what they wish with those records, including providing it to 3rd parties. Also, many letters are more appropriately handled by a primary care medical doctor or a psychiatrist. Encouraging your client to pursue their letter needs from another professional is often an appropriate route to take.

  • Do I need an ROI when I write a letter for a  client?
    A Release of Information is not required when providing letters directly to a client.  A Release of Information is necessary when sending a letter to a non-covered entity.  

  • Does Rula have any templates I can use to write a letter?
    No. Due to each Rula therapist being an independent private practice therapist, as well as each client having individualized, unique needs within these requests, Rula does not provide any sample letters or templates.


You can reach out to quality@rula.com if you have additional questions or support needs related to writing letters for clients. Therapist to therapist - we’re here for you!

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