Medical Leave of Absence Letter — Free Template
A medical leave of absence letter asks for time off to deal with your own health: surgery, recovery, treatment or a serious illness. It should give clear dates, confirm that a doctor supports the leave, and explain how you'd like to handle pay, without sharing more medical detail than you're comfortable with.
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October 15, 2026
[Your manager or HR contact]
[Company name]
Re: Request for medical leave
Dear [Your manager or HR contact],
I am writing to formally request medical leave beginning [First day of leave]. I plan to return to work on [Expected return date].
[Why you're requesting leave]
I am happy to complete any forms or provide any documentation needed to support this request. Please let me know if you approve, or if you would like to discuss the dates or arrangements. I appreciate your understanding and support.
Sincerely,
[Your full name]
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How much medical detail to share
You generally need to tell your employer enough to show that you need medical leave and roughly how long, but you don't usually need to give a diagnosis. A sentence like my doctor has advised surgery followed by six weeks of recovery is often enough, with a doctor's note to back it up.
If you'd like the leave to count under FMLA or a state medical leave law, your employer may ask your doctor to complete a certification form. That form covers the medical facts, so your letter can stay brief.
Pay during medical leave
Medical leave may be unpaid under federal law, but you may be able to use paid sick leave or paid time off, short-term disability insurance through your employer, or a state disability or paid leave program in states that have one. Ask HR what's available and include your preference in the letter.
If your return date is uncertain, say so and give your best estimate. You can update your employer as your recovery progresses.
Returning to work
Your employer may ask for a doctor's note clearing you to return. If you'll need adjustments when you come back, such as lighter duties, a modified schedule or time for follow-up appointments, raise that early. These may be reasonable accommodations under disability laws.
If your recovery takes longer than planned, contact your employer before your expected return date rather than after. A short extension request, with an updated note, keeps your job situation clear.
What to do, step by step
Read your company's leave policy
Check your employee handbook for the types of leave offered, how much notice is required, whether leave is paid, and which forms HR needs. Ask HR if anything is unclear.
Find out what protections may apply
Depending on your employer's size, how long you've worked there and where you live, federal or state family and medical leave laws may protect your job during certain kinds of leave. HR can tell you whether you're eligible.
Fill in your letter
Answer the questions above. Give clear dates, a brief reason, your plans for pay or paid time off, and how your work will be covered.
Give as much notice as you can
For planned leave, such as a birth or a sabbatical, many policies ask for 30 days' notice or more. For emergencies, send the letter as soon as you reasonably can.
Get the answer in writing
Send the letter to your manager and HR, keep a copy, and ask for written confirmation of your approved dates and pay arrangements before your leave starts.
What if your employer denies your leave request?
Ask for the reason in writing. Some leave, such as a sabbatical or extended personal leave, is entirely at your employer's discretion. Others may be protected: eligible employees can generally take up to 12 weeks of unpaid, job-protected leave a year under the federal Family and Medical Leave Act for their own serious health condition, a new child or caring for a seriously ill family member.
If your leave may be protected and your employer refuses, ask HR exactly which policy or rule they're relying on. Many states have their own family leave, paid leave or pregnancy-related protections that go further than federal law. Your state labor department can explain what applies to you.
If a full leave isn't possible, consider asking for a compromise: different dates, a shorter leave, a phased return or reduced hours. If you believe you were denied leave you're entitled to, or treated badly for asking, contact the US Department of Labor or a legal aid organization for help.
Example medical leave of absence letter
A filled-in sample with made-up details, so you can see the finished result.
Natalie Brooks
October 5, 2026
Karen Chen
Summit Health Partners
Re: Request for medical leave
Dear Karen Chen,
I am writing to formally request medical leave beginning November 2, 2026. I plan to return to work on December 14, 2026.
My doctor has advised that I need surgery followed by a recovery period of about six weeks, during which I will be unable to work. I can provide a note from my doctor confirming the dates.
I would like to use my 64 hours of accrued paid time off first, with the remainder of my leave unpaid. I would also like to apply for short-term disability benefits if I am eligible.
To keep things running smoothly while I am away, I plan to do the following:
Before my leave, I will finish the Q4 billing reconciliation and write a handover document for Luis Ramirez, who has agreed to cover my daily claims queue.
While I am on leave, I can be reached by email at natalie.brooks@email.com for urgent questions.
I am happy to complete any forms or provide any documentation needed to support this request. Please let me know if you approve, or if you would like to discuss the dates or arrangements. I appreciate your understanding and support.
Sincerely,
Natalie Brooks
Frequently asked questions
Can I be fired while on medical leave?
If your leave is protected by FMLA or a state law, your employer generally can't fire you for taking it, and you're usually entitled to return to the same or an equivalent job. Protection depends on eligibility, so confirm with HR whether your leave qualifies.
What if I'm not eligible for FMLA?
You may still have options: company medical leave, paid sick leave under a state or local law, short-term disability, or leave as a reasonable accommodation under disability laws. Ask HR, and check your state labor department's website.
Should I send the letter before or after surgery?
For planned surgery, send it as early as you can, ideally 30 days or more beforehand. For an emergency, tell your employer as soon as possible and send the letter when you're able, or ask a family member to contact HR for you.
What should a leave of absence letter include?
Your name, the date, who it's addressed to, the type of leave, your first day of leave and expected return date, a brief reason, how you plan to handle pay or paid time off, how your work will be covered, and an offer to provide paperwork or discuss the arrangements.
Do I have to tell my employer why I need leave?
You usually need to give enough information for your employer to know what kind of leave you're requesting, especially if you want it to count as protected medical or family leave. You don't generally have to share a detailed diagnosis; a doctor's note confirming you need time off is often enough.
FairLetter is not a law firm and does not provide legal advice. Letters are templates you customize and send yourself.