www.marshallortho.com
                                                                                                                                      

   Douglas A. Waldman, MD

304 University, Suite 212      Marshall, Texas 75670-5247

Phone [903] 935-1151 -- Fax [903] 935-0077

SCHOOL / WORK EXCUSE

Patient Name:

Medical Condition : 

Work / school excuse for :

No athletics until: 

May return to work / school / athletics :

____________________________________________________________________

                         Douglas A. Waldman, MD

Date: