Professional Physician's Note

DoB: [Patient's Date of Birth]

To Whom It May Concern,

I, Dr.                               , a licensed physician at                               , have evaluated

[Your Name] [Medical Facility Name]

                              on                               . After a thorough assessment, it has been

[Patient's Name] [Date of Examination]

determined that the patient is experiencing                                                             , which

[Diagnosis or Medical Condition]

requires                                                             .

[specific treatment or rest period]

Based on my medical advice, the patient will need to refrain from work/school/daily activities from                                to                               .

[Start Date] [End Date]

If further medical attention is required, I will provide an updated evaluation. Should you have any questions or require additional documentation, please feel free to contact my office.

Physician’s Signature
Dr. [Your Name]
[Medical License Number]