HOUSE OF KIN
PROOF OF MEDICAL TREATMENT

 Hospital Staff:

We are requesting your assistance. Please help us to ensure that we are offering our medical discount to those who are in need. We ask that you confirm that our guest(s) (patient or their family members/friends) are here receiving medical treatment(s) in Sudbury. Simply complete our form and provide a hospital site or physician stamp to verify information on the form is correct. This will assist us in making sure that those people who are in need of assistance are receiving our special hotel medical discount rate.

Unfortunately, simply signing this form without having the medical verification stamp shown is NOT sufficient to warrant consideration for the special rate.

Name:___________________________________

Address:______________________________________

Town/City_____________________________________

Phone Number: (___) __________________________

Physician:_____________________________________