You can open the Jury Duty Medical Excuse Letter Template in multiple formats, including PDF, Word, and Google Docs.
Jury Duty Medical Excuse Letter Template Printable | Editable FormSample
Examples
[Jury Administration Office]
[Office Address]
[City, State, Zip Code]
[Your Name]
[Your Address]
[City, State, Zip Code]
[Your Phone Number]
[Your Email]
[Current Date]
Medical Excuse for Jury Duty
I am writing to formally request an excuse from jury duty due to medical reasons. I was summoned to appear for jury duty on [Jury Duty Date]. Unfortunately, due to my current health condition, I am unable to serve at this time.
I have been diagnosed with [Specify Medical Condition], which has led to [Briefly explain symptoms or treatments that prevent you from participating in jury duty]. In light of this situation, my healthcare provider has advised that I refrain from any obligations that may further compromise my health.
Attached to this letter is a statement from my physician, Dr. [Physician’s Name], which confirms my medical condition and the necessity for my absence from jury duty. The recommendation specifically states: [Include relevant recommendations or restrictions from the physician].
I sincerely apologize for any inconvenience this may cause and I appreciate your understanding in this matter. I am willing to provide any additional documentation required to support my request for an excuse.
[Your Signature (if sending a hard copy)]
[Your Name]
[Jury Administration Office]
[Office Address]
[City, State, Zip Code]
[Your Name]
[Your Address]
[City, State, Zip Code]
[Your Phone Number]
[Your Email]
[Current Date]
Request for Medical Exemption from Jury Duty
I am writing to formally request an exemption from jury duty on [Jury Duty Date] due to medical reasons that prevent me from serving effectively.
I am currently undergoing treatment for [Specify Medical Condition] which requires [Brief description of treatment or condition’s effect on your ability to serve]. Due to the nature of my condition, it is essential for me to prioritize my health and follow my doctor’s advice to avoid stressful obligations.
I have included a letter from my healthcare provider, Dr. [Physician’s Name], verifying my condition and recommending that I be excused from jury duty at this time. The doctor’s letter states: [Summarize key points from the doctor’s letter].
I kindly ask you to consider my situation and grant me an exemption from jury duty. I am grateful for your understanding and support regarding this serious matter.
[Your Signature (if sending a hard copy)]
[Your Name]
Format
Please complete the form below to create the Jury Duty Medical Excuse Letter Template. All fields must be filled out to ensure a clear and complete communication. We provide examples to guide you through each step. Jury Duty Medical Excuse Letter Template 1. Personal Information 2. Court Information 3. Medical Information 4. Medical Excuse Details 5. Treatment Information 6. Duration of Excusal 7. Physician’s Statement 8. Signatures and Date Physician’s Signature:
PDF
WORD
Google Docs
Jury Duty Medical Excuse Letter Template Printable | Editable FormPrintable
