Letters from Two Physicians
All letters MUST be on letterhead and contain a proper signature
Letters MUST be uploaded into the online application – DO NOT MAIL TO UCNS
<Date>
To: UCNS Certification Department
Dear Certification Department:
This letter serves as documentation of Headache Medicine practice time for the individual
listed below.
1. Applicant name and credentials:
2. Number of years familiar with the applicant’s practice pattern:
3. At least 25% of the applicant’s practice during the past 36 months has been devoted to
Headache Medicine Yes ☐ No ☐
Sincerely,
<Must include a handwritten, digitized, or electronic signature equivalent: /John Doe/>
Name and credentials:
Name of institution:
Address:
Phone number:
Email:
UCNS HM Template Letter – Letters from Two Physicians