Wellness Day Request Form
Wellness Day Policy is as follows:
1. Each resident is eligible for 2 wellness days per academic year.
2. They must be requested at least 30 days in advance to ensure adequate coverage and minimal disruptions to workflow.
3. Wellness days cannot be
- Carried over to subsequent training years
- Used to extend any type of leave (vacation, sick, FMLA)
4. Both wellness days cannot be taken 
- Together along with a weekend to avoid back up call burden on other residents & reduce the number of residents whose wellness days can be approved.
- During the same 2 week block elective to ensure adequate number of days on the elective for a good learning experience
5. Wellness days cannot be requested during ER, Inpatient Floor, Nursery, MSK, NICU or PICU rotations, as well as, when assigned for backup call or continuity clinic.
6. No wellness days will be approved for Block 13 for the academic year 2024-2025. 

Please note that the wellness day requests are reviewed on a weekly basis & thus we request you to please give it at least a week from the date of submission for the response.
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Full Name *
Dates(s) requested (Please also include the day of the week) *
Scheduled rotation during the requested dates *
Does the requested date fall on your clinic day *
Any comments by the resident
For Chiefs Only
Any scheduling conflicts observed
Submit
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