Leave of absence request | Bridges Professional Treatment Services

You must request a leave of absence if you cannot attend any scheduled program component for 21 days or longer. Submit your request with documentation two weeks before the leave.

Fields marked (required) must be filled in. Your information is sent securely and stored encrypted.

First name (required)

Last name (required)

Phone (required)

Email (optional)

Your group number (required)

Date of birth (required)

Reason for the leave (required) Military orders or responsibilities requiring an extended absence Work that requires travel for an extended period My own extended illness or medical treatment, or that of a family member Incarceration, or a residential recovery or treatment program Extreme personal hardship or family emergency Vacation (only if all absences are made up and fees are paid)

Leave starts (required)

Planned return date (required)

Explain the circumstances (required)

If you are asking for approval after the fact, explain what prevented you from asking ahead.

Supporting documents (optional)

PDF, JPG or PNG, up to 10 MB each. You can also upload later or bring them to the office.

I understand a leave of absence fee applies, missed components are added to the end of my schedule, and I have 21 days from my return date to attend a Return from LOA appointment. (required)