Leave of Absence Request | Ashley Addiciton Treatment

Leave of Absence’s are reserved for legal, medical and other outside appointments as well as post family session trips and typically only last a few hours.
Please allow for 48 hour notice for Leave of Absence approval so that pick up and return time may be coordinated with staff.
Leave of Absence passes must be approved by assigned Counselor, Director of Emerging Adult Services or Extended Care Operations Manager.

Name(Required)

First Last

Date(Required)

Requested Date of LOA(Required)

Estimated Time of Departure(Required)