Does anyone have a template for the letter?

I have almost no medical history (I've only been to the doc twice in the past 15 years and those were both in the last 2 years), and no diagnosed comorbidities. I have a family history of diabetes and heart disease, so I know I'll develop them in time, but I'd like to get the problem fixed pre-emptively. Has anyone in a similar situation been approved, and if so, is there a copy of the letter I could use as a template for my doctor?

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