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Doctor’s Note Template
A doctor’s note confirms that you assessed a patient, and says when they can’t work or attend school, and when they can go back. Copy the blank note or download it, with a work example, a school example, and what to leave out.
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- Word and text downloads
- Two filled examples
Blank doctor’s note template
FreeDOCTOR'S NOTE [Practice name] [Address] [Phone and email] Date issued: [Date] To: [Employer or school, or To whom it may concern] Re: [Patient's full name] Date of birth: [Date] I assessed [patient name] [in person, by video, or by phone] on [date of the visit]. Unable to [work or attend school]: [From first date to last date, or not needed] Dates before the visit: [None, or the dates, based on what the patient told me] Expected return: [Date, or the date I will reassess] Restrictions on return: [None, or what they should not do and until when, e.g. no gym or sports for 2 weeks] Diagnosis: [Only if the patient asks for it to be included; otherwise delete this line] To confirm that this practice issued this note, call [practice phone]. We will confirm only that the note is genuine. [Your name, credentials] [License or registration number] [Signature]
Use it for
- Sick days from work
- School absences
- Gym and sports limits
- Modified duties on return
- Video and phone visits
Two filled examples. Every part, filled in.
Each one follows the template. Use them to judge how much detail every part needs.
Doctor’s note for work: 3 days off
Family practice, same-day visit for acute gastroenteritis
The visit
I assessed this 34-year-old patient in person on Tuesday, October 6, 2026.
Dates off
Unable to work from Monday, October 5, to Wednesday, October 7, 2026: 3 working days.
Before the visit
October 5 is before my assessment. It is based on the patient’s account that they became unwell that morning and stayed home.
Return
Expected back at work on Thursday, October 8, 2026, with no restrictions. If they are not better by then, I will reassess.
Diagnosis
Not included, at the patient’s request.
Verification and signature
To confirm that this practice issued this note, call the number above. Signed by the family physician, with credentials and registration number, on practice letterhead. Issued October 6, 2026.
Doctor’s note for school: gym and sports limits
Family practice, in-person visit with a parent
The visit
I assessed this 13-year-old student in person on Tuesday, October 13, 2026, with a parent present.
School
Can attend school as usual from Wednesday, October 14, 2026.
Restrictions
No physical education class or sports, including team practices and games, for 2 weeks, until Tuesday, October 27, 2026. For the same 2 weeks, please allow extra time to move between classes, and use of the elevator.
Diagnosis
Right ankle sprain. Included with the agreement of the student and their parent, so teachers and coaches understand the limits.
Reassessment
I will review the ankle on October 27, 2026, and advise on a gradual return to sports. If the school uses its own return-to-play form, I can complete it then.
Verification and signature
To confirm that this practice issued this note, call the number above. Signed by the family physician, with credentials and registration number, on practice letterhead. Issued October 13, 2026.
What goes in each part.
Practice and date
Who issued the note, and when, so the reader knows where it came from.
- Your practice’s name, address, and phone
- The date you wrote the note
- Who it is for, or “To whom it may concern”
Avoid: A note on plain paper with no contact details. No one can check it.
The visit
That you saw and assessed the patient, when, and how.
- The patient’s full name and date of birth
- The real date of the visit
- In person, by video, or by phone
Avoid: A visit date earlier than the visit. If the note covers earlier days, say so on its own line.
Dates off
The days the patient can’t work or attend school, and when they can go back.
- The first and last date
- Which dates came before the visit, based on the patient’s account
- The expected return date, or the date you will reassess
Avoid: Open-ended time off. Give an end date or a review date.
Restrictions on return
What the patient can’t do yet, if anything, and for how long.
- “None,” when there are none
- Specific limits, such as no lifting, seated work only, or no gym
- When the limits end, or when you will review them
Avoid: “Light duties” with no detail. Say what they can’t do.
Diagnosis
Usually left out. An employer or school generally needs the dates and any limits, not the diagnosis.
- Only with the patient’s consent
- For a child, follow your local rules on who consents
- In the words the patient agreed to
Avoid: Adding it because the line is there. Delete the line instead.
Verification and signature
Your details, so the note can be traced to you and checked.
- Your name and credentials
- Your license or registration number
- Your signature
- A practice phone number for verification
Avoid: Saying more than “yes, I wrote it” when someone calls to check. Share nothing else without the patient’s consent.
Common mistakes, and how to avoid them.
A visit date that isn’t real
Write the date you actually saw the patient. If the note covers earlier days, list them and say they rest on the patient’s account.
The diagnosis by default
An employer or school generally needs the dates and any limits, not the diagnosis. Add it only when the patient asks.
Limits no one can act on
“Light duties” or “take it easy” means something different to every reader. Say what the patient can’t do, and until when.
No end date
An open-ended note leaves the employer or school guessing. Give a return date, or the date you will reassess.
More than you assessed
Write only what you saw and assessed. If you can’t confirm a date or a limit, leave it out or say why.
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Frequently asked questions.
What should a doctor’s note for work include?
Your practice details, the date of the visit and whether it was in person, by video, or by phone, the dates the patient can’t work, the expected return or reassessment date, and any restrictions. Sign it with your name, credentials, and license or registration number. Leave out the diagnosis unless the patient asks for it.
What goes in a doctor’s note for school?
The dates the student missed or will miss, whether they can attend, and any limits, such as no gym or sports, with an end date. Many schools and sports leagues also have their own forms for medication or return to play.
Does a doctor’s note have to include the diagnosis?
No. An employer or school generally needs the dates and any limits, not the diagnosis. Include it only with the patient’s consent.
Can an employer ask for a doctor’s note?
Usually, yes, though some places limit when an employer can ask, for example for short absences. Check the rules where you and your patient are.
Can I backdate a doctor’s note?
Never date the visit earlier than it happened. You can cover days before the visit, but say those dates are based on what the patient told you.
What should I say if an employer calls to verify a note?
Confirm only that you wrote it. Share nothing more, such as the diagnosis, without the patient’s consent or other legal authority. If you didn’t write it, or it has been changed, keep any answer to that, and get advice if you are unsure.
Is this doctor’s note template free?
Yes. Copy it, or download it as a Word or text file. No account needed.
Can Vero write a doctor’s note from my visit?
Yes. Paste this template into Vero, and it drafts the note from your visit, with the dates and limits you discussed. Review and edit it, then export it to PDF or Word, print it, or email it.
More templates, and guides.
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Pregnancy accommodation letter template
To an employer: the pregnancy-related limitation, the change needed at work, and how long it lasts.
Lactation accommodation letter template
For pumping or breastfeeding at work: the breaks, the space, any medical reason, and an end date.
Telehealth visit note
Record the video or phone visit a note is based on.
Vero Documents
Fill employer, insurer, and leave forms from the visit and the chart.
Medical forms library
Disability, leave, and insurer forms, with official links and how to file.
Your template. Filled in from the visit.
Vero writes your notes and letters in the templates you choose, so you review instead of type.
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