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All of my academic LoRs are through VirtualEval, and I have one physician's LoR that he suggested he'd prefer to send by mail rather than via Interfolio.
I've also read that some school only want LoRs with secondaries. And secondaries usually come in July/August, correct? If so, then I'll use secondaries as my time reference for when to have my LoR sent.
In my experience, LoR's should only be sent to schools that have sent you a secondary application.