If you have any questions regarding your doctor's note, please contact us through live chat, email, or the form provided below.
Patient name
Your Name
Date
Diagnosis
Doctor signature
All three arrive in one email. You don’t need to upload anything from AtoZ we already have Amazon’s forms. Just sign the E117 by hand before you submit to DLS.
Physician-signed doctor's note
Health Care Provider Form (signed)
Authorization to Disclose Information
A standard doctor’s note is $49. The Amazon DLS service is free because we also generate and sign the E103 Health Care Provider Form and prepare the E117 Authorization - both completed by doctor, no upload needed.
Compare to a traditional clinic: ~$70 per form, 7–10 day wait, requires an existing patient relationship. By the time the form is filled, your UPT bucket is empty and ADAPT has already added the points.
Simple, Hassle-Free, and 100% Legal
How it Works?
Employers and professors can directly call the issuing doctor to verify any note. Your organization can contact our doctor or support team to confirm submitted details. All verification information is clearly listed on every doctor’s note for quick, trusted confirmation.
Sections A–D filled in by a licensed physician prepared from your intake, no upload required
Separate physician-signed note for your records, with QR-verifiable physician credentials
Most forms returned within hours beats the 7–10 day clinic wait
Optional: we fax the completed form to directly so DLS receives it on your behalf
Authorization for DLS / WorkCare to contact us back with follow-up available if your case manager asks for it
Encrypted intake, encrypted storage, BAA-covered subprocessors
Learn why thousands nationwide choose DoctorNote.health
DLS form due back?
A doctor can complete it now
Tell us your symptoms and your Amazon job title. We prepare and sign the E103, sign it, and have it ready to submit to DLS before your next shift starts. No AtoZ upload, no points.
$49 | includes E103 + E117 forms | Refund if not approved