School Excuse Request

Complete the request, save it as a PDF, and email the PDF to our office. After review, the office will apply Dr. Sibel Eljach's authorized signature and return the approved excuse to the email provided below.

Request Information

Parent or Guardian Name Return Email

Student Name School Name

Request Date Appointment Date

Excused From Return Time

To Whom It May Concern:

The student named above was seen at COCO Smiles Orthodontics for an orthodontic appointment on the date provided.

Please excuse this student from school during the requested appointment period.

If additional information is needed, please call our office at 305-786-4964.

Office Approval

Doctor: Dr. Sibel Eljach, DMD, MS

Authorized Signature:

How to Submit

Select Save School Excuse PDF, then choose Save as PDF in the print dialog.
Select Email PDF to Office to open a message addressed to admin@cocosmilesorthodontics.com.
Attach the PDF you saved and send the email. The office will review, sign, and return it to your return email.