Application format for Issuance of Health Certificate for Employees

[This is a sample application format for the issuance of health certificate from a hospital, doctor, medical, approved or on panel labs for employees. Sometimes employees take leave for a health issue after recovery s/he needs Issuance of Health Certificate to show cause of leave. You can modify this formats as your requirement.]

Date…

The Surgeon/General physician,

Institute Name…

Institute Address…

Sub: Issuance of Health Certificate

It is to inform you that I was your patient at about a week ago (Date), as I was suffering from a cough and cold (Disease type). Through your recommended prescription I got a cure. As I am an ordinary servant in a multinational company, during the days of my bad health I took off from the job but now the company is demanding for the health certificate for their documentation work to keep the record.

In this scenario, kindly issue me the health certificate. I will be very thankful to you for this kind act.

Truly your’s

Name…

Job Designation…

Address…