Your full name, job title
City, State, Zip code
Mr./Mr. Last Name:
I am writing to you to submit a formal request for a medical leave of
absence due to my own serious health condition that requires surgery. My
doctor has scheduled a surgical procedure for (insert date) and expects
that I will need (insert number) of weeks for recovery before being
released to return to work. My physician will be happy to provide a
formal medical certification document on my behalf.
Please let me know the next steps I should take to secure approval for
this request. Thank you in advance for your consideration.
Your typed name