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Free Leave of Absence Request - Medical Treatment

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Dear _________________:

 

I am writing to request a _________________ _________________ leave of absence, beginning _________________.

 

My physician has informed me that I need _________________. The doctor has further indicated that this period of time should be ample to allow for my complete recovery.

 

Please let me know your response to this request as soon as possible.

 

Sincerely,

 

 

 

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