bestmedicalforms.

com Medical certificate request letter

From

[The Doctor’s Name]

[Qualification]
[Address]

Sub: Application for issuance of a medical certificate

With due respect, I would like to request you issue me a medical certificate. I am (mention your
name), resident of (mention the location). I am a patient with chronic kidney disease who has
been taking treatment from you for the last 5 years. Recently, I was not feeling well and visited
you before the appointment time. After seeing my condition, you asked me to take a rest for 10
days.

I am a student of an engineering university and we are strictly forbidden to take such a long
leave unless we have a genuine reason. Although I have a genuine reason, I don’t have any
proof. Therefore, I am writing this letter to you to ask for the medical certificate.

With the help of this medical certificate, I will be able to get approval for the medical leave I
have applied for. This certificate will also be very helpful for me in a number of ways. Therefore,
it is a humble request to you to please write me a certificate as soon as possible. I shall be very
thankful to you for this act of kindness.

For making it easy for you, I am attaching my prescription with this letter. I am looking forward
to a kind response from your side.

Doctor’s Name

Name of the department of practice

Signature

[DATE]

[Date]