Medical Leave Request Letter PDF – Free Generator

Draft a polite medical leave request with dates, reason, documentation notes, and a signature block ready for HR.

Employee name

Job title

Department

Employer

Employer/HR address

HR contact name (optional)

Leave type

Start date

End date

Intermittent leaveI will provide documentation if needed

Notes or scheduling details

Safety notes

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Review details before sending; nothing here is legal advice or a substitute for local forms.