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Fillable Form Excuse Note

An Excuse Note is a short note or letter that is submitted in order to explain the need for a person’s absence at work or school, or simply justify a person’s absence.

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What is an Excuse Note?

An Excuse Note is a short note or letter that is submitted in order to explain the need for a person’s absence at work or school, or simply justify a person’s absence. Excuse notes are often submitted alongside a medical certification, or doctor’s notes, from a doctor (as in the case of this excuse note) or some other document that will help prove the legitimacy of the excuse.

Excuse notes are often necessary or at the very least asked for from absentees in order for teachers, or employers and supervisors, to be able to have confidence that there was a reasonable explanation for a student or employee’s absence. This is because explanations and excuses that are deemed unacceptable may result in the student or employee facing certain consequences according to the rules outlined by the school or their workplace. Absences must be justified as they can, in the case of a student, cause disruptions in teachers’ lesson plans (as they may have to try and help the absentee student catch up with the rest of the class) or, in the case of an employee, cause disruptions in the workplace or be a breach in any agreements made between the employee and their boss(es).

There are many different reasons that may cause a person to be unable to go to work, ranging from injuries to illness to family and other personal emergencies. An excuse note’s purpose is to make a teacher or employer aware of this reason. Excuse notes are not legally binding notices in most circumstances, however, so it is important to keep the policies that the school or workplace has regarding a student or employee’s absence in mind when submitting an excuse note, so as to be prepared for any possible consequences or obligations that may come as a result of being absent.

Who needs to use an Excuse Note?

A student or employee may need to use an excuse note if they are aware that they will be absent for one or more days from school or work.

It is important to note, however, that this particular form, being a medical excuse note, assumes that the reason for the absence will be medical in nature, or at least related to a medical reason.

How to fill out an Excuse Note?

Get a copy of Excuse Note template in PDF format.

As mentioned above, this particular excuse note is used when a student or employee has a medical reason for not being able to attend school or work. Make sure to bring this form when going to the doctor if you or another person expects to have to be excused from school or work, so that the doctor can more directly enter the necessary information.

Doctor’s Name

Enter the doctor’s full name.

Doctor’s Address

Enter the address of the doctor’s clinic or hospital that they primarily work in. This will be important if or when the school or employer wishes to contact the doctor in order to confirm the veracity of the excuse note.


Enter the date that the doctor issued the excuse note.

Name of the Excused

Enter the full name of the person being excused from school or work.

Excused From

Check the box corresponding to what activity or otherwise the person is being excused from. You may choose from the following:

  • Work
  • School
  • Other (Enter the relevant activity in the space provided)

Reason for Excuse

Check the box corresponding to what the reason for requesting to be excused is. You may choose from the following:

  • Injury
  • Illness
  • Other (Enter the relevant reason in the space provided)

Note that since this form assumes that you are requesting that a doctor provide the certification of your excuse (via signing), it must also be assumed that the reason for being excused will be related to your health in some way.

Date or Period to be Excused

Enter the date(s) or period of time that the person must be excused for.

Doctor’s Comments

The doctor should put any important comments, especially those regarding the reason for the excuse, here.

For example, it may be beneficial for the doctor to outline the factors of the illness or injury that make it difficult or impossible for the student or employee to go to school or work, such as very high fever, or coming down with a particularly severe or contagious disease. Comments should be clear and concise in order to make them as easily understandable by the person reading them as possible.

Doctor’s Name and Signature

Have the doctor sign the excuse note and write their name in the space provided.

Arrange for Submission

Depending on the circumstances of the person being excused, the excuse note may need to be either given to someone to be submitted physically (whether through mail or personally), or through alternative means, such as scanning the excuse note and sending the scanned copy through email.

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Tips when filling out an Excuse Note

It is very important to remember that, even if your excuse is accepted, you may still have to make up for the lessons or work that you missed during your absence. Make sure that you are able to do so, or will at least be aware of what you will have to do that you missed during your absence.

For students, make sure you have a friend that can tell you about the schoolwork assigned during the time you are absent. This is very important so that you can minimize the amount of homework and schoolwork you miss while absent, and so you can keep up with the rest of the class and avoid being too negatively affected by being absent. This is especially important if you are absent for a particularly long time.

Keep in mind your school’s rules regarding absences. Some schools may have particular rules surrounding absences and the amount of time for which a student is absent from school. Keep these rules in mind to avoid any issues or to know what is expected of you once you return from your absence.

For employees, keep in mind the terms of your employment or contract. Make sure that you are aware of any consequences or requirements for absences at work, to avoid issues arising from any breaches of agreements you may have entered as part of your work or any rules that your workplace has regarding absences.

Make sure that your excuse is truthful. This is vital to avoid having to face any particularly severe consequences (which in some cases may even be legal in nature) that may arise due to lying.

Keep a copy of any prescriptions or diagnoses made by the doctor. This will function as extra proof in the event that the person who receives the excuse note asks for more concrete evidence that a doctor has signed off on your excuse note. Doctor notes are also important to be able to understand what is expected to do to ensure a speedy recovery.

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