Medical Leave of Absence Example Letters

Updated January 10, 2020
Leave of Absence Letter Sample

If you need to take an extended period of time off for work for medical reasons, it's a good idea to submit a formal letter of request to your employer. Before writing your letter, make sure you are aware of company policies regarding medical leave and find out whether or not your employer is covered under the Family Medical Leave Act (FMLA). The sample letters below can be downloaded and customized using Adobe, then printed out and signed.

Sample Letters for Medical Leave Requests

Three of the most common reasons to submit a letter to request time off from work in the form of a medical leave of absence are surgery, diagnosis of a serious illness, or a chronic condition that may require intermittent leave. Use the letters in this section if you need to request medical leave but are not eligible for Family Medical Leave (FML). Skip to the next section if FML would apply in your situation.

Medical Leave of Absence Request: Surgery

This letter is an appropriate template to use if you are requesting medical leave for surgery.

Medical Leave of Absence Request: Serious Illness

This template is a good option if you are requesting medical leave in order to recover from a serious illness.

Medical Leave of Absence Request: Intermittent Leave

This template is appropriate if you have a medical condition that will require you to miss work on a recurrent basis over a period of time, such as for weekly or monthly treatments or periodic flare-ups.

Sample FMLA Letter to Employer

If your U.S. employer is covered by the FMLA, you are eligible for FML, and the reason you need leave is one that qualifies for FML, use this version of the letter instead of the ones above. This template can be adjusted to any FML qualifying situation, including serious illness (your own or that of a parent, child, or spouse), intermittent leave, pregnancy, or becoming a parent (mother or father) through birth, adoption or foster care.

Note: You'll need to attach appropriate documentation along with this letter. To ensure the approval process goes as quickly as possible, it's a good idea to reach out to your company's leave administrator (typically in the HR department) to verify exactly what paperwork will be required so you can be proactive in getting it completed in time to submit along with your letter. This will help to reduce the amount of back and forth required to get a decision.

Tips for Requesting Medical Leave

Keep these tips in mind when you find yourself in need of a medical leave of absence from your job.

  • Be sure that you know and follow your company's policies regarding leave requests and be sure that you follow the requirements exactly. Most companies have specific guidelines that employees must follow when requesting leave. Look in your employee handbook for your company's policies or ask your company's human resources representative for information. If your company does not have an HR department, ask your supervisor or the office manager who is responsible for employee leave requests and reach out to that individual.
  • It's advisable to begin the process of requesting approval for medical leave as soon as you know that you need time off from work for a qualified situation. Most companies request 30 days advance notice when it is practical. The fact that you are writing a letter of request will not excuse you from following official company procedure. Do not assume that your request has been approved simply because you submitted a letter. If you don't get a response within a few days, follow-up to check on the status and find out what (if anything) you can do to expedite the process.
  • Be prepared to complete official FMLA forms to request leave and for medical certification if you are eligible for this type of leave and if your company is covered by the law. See to learn more about FMLA eligibility and requirements. Even if your company is not obligated to provide you with leave under FMLA, your request may be granted if doing so is practical for the organization.
  • Your employer may need to communicate with your healthcare provider in order to approve medical leave. If this is the case, it will be necessary for you to sign a medical release form giving your doctor or other healthcare provider permission to share certain information with your medical records with a representative of your employer.

Reasonable Accommodation Considerations

If the reason you need leave is protected as a disability under the Americans with Disabilities Act (ADA), you may be able to request leave as a reasonable accommodation for your disability. If your company is not covered under FMLA and does not grant medical leave as a matter of policy, your initial request can be for a reasonable accommodation. If your company does provide FMLA or policy-based leave, but you need more time off for your health condition, requesting extended leave as a reasonable accommodation may be a good option for you. Learn more about disability rights and laws at

Trending on LoveToKnow
Medical Leave of Absence Example Letters