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Time Off Request Form
Your Name
*
Clinic
*
Albuquerque
Amarillo
Corpus Christi
El Paso
Lubbock
Midland
Corporate
Today's Date
*
+
Time Off Type
*
PFP (Pay For Performance)
Vacation
Sick
Jury Duty
Bereavement
I am having a Bad Hair Day!
I won the Lottery!...I'm calling in Rich!!
Other
1st Date Off Work
*
+
Date Returning To Work
*
+
Total # of Days I will be Out
*
1 Day - Just Need a Day to get Stuff done
2 Days - Can't get it done in 1 Day so....
3 Days - Just the right amt of time for some R&R
4 Days - R&R Plus a few crazy times :)
5 Days - I'm going to have some fuunnnn!!!
Other
Notes (If any)
*
🛈
Notify Dr Kanase immediately!