Resident Medical Leave Request Form

Please complete all of the fields.

For single illness please select Medical Absence > 5 days.

By clicking submit this form will be sent to the Lead Residents and Program Administrators. Requests requiring Program Director approval will be communicated to the requesting resident. 

Have you let your preceptor know?
Have you provided a medical note?

Collection of personal information
Your personal information is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection or use of this information, please visit our Access to Information page.