You can open the Excuse From Jury Duty Letter From Doctor Template in multiple formats, including PDF, Word, and Google Docs.
Excuse From Jury Duty Letter From Doctor Template Printable | Editable FormSample
Examples
[Doctor’s Name]
[Doctor’s ID or License Number]
[Doctor’s Practice Name]
[Practice Address]
[Practice Phone]
[Practice Email]
[Date]
[Juror’s Name]
[Juror’s Address]
[City, State, ZIP Code]
Excusal from Jury Duty
I am writing to formally excuse [Juror’s Name] from jury duty scheduled for [Date of Jury Duty] due to medical reasons.
[Juror’s Name] has been under my care since [Date Patient Started Treatment]. At this time, [he/she/they] is experiencing [describe the medical condition] that prevents [him/her/them] from attending jury duty. It is crucial for [his/her/their] recovery that [he/she/they] avoids [explain any activities or stress that should be avoided].
In my professional opinion, it is in the best interest of [Juror’s Name]’s health that [he/she/they] be excused from serving on the jury. I recommend rescheduling [his/her/their] service to a later date when [he/she/they] is medically able to participate.
Thank you for your understanding and consideration regarding this matter. If you have any questions or require further information, please do not hesitate to contact my office.
[Signature of the Doctor]
[Doctor’s Name]
[Doctor’s Title/Position]
[Doctor’s Name]
[Doctor’s ID or License Number]
[Doctor’s Practice Name]
[Practice Address]
[Practice Phone]
[Practice Email]
[Date]
[Juror’s Name]
[Juror’s Address]
[City, State, ZIP Code]
Request for Excusal from Jury Duty
I am writing on behalf of my patient, [Juror’s Name], to request an official excusal from jury duty scheduled for [Date of Jury Duty].
[Juror’s Name] is currently undergoing treatment for [specify medical condition], which significantly impacts [his/her/their] ability to concentrate and perform jury duties effectively. Regular attendance to doctor’s appointments and medical therapy necessitates [his/her/their] time and physical presence.
It is my professional recommendation that [he/she/they] be excused from participating in jury duty at this time to allow for [his/her/their] necessary treatment and recovery period.
I appreciate your attention to this matter and your understanding of the importance of [Juror’s Name]’s health. Please feel free to contact me if you need any further verification regarding this request.
[Signature of the Doctor]
[Doctor’s Name]
[Doctor’s Title/Position]
Format
Please complete the form below to create the Excuse From Jury Duty Letter From Doctor Template. All fields must be filled out to ensure a proper and complete letter. We provide examples to guide you through each step. Excuse From Jury Duty Letter From Doctor Template 1. Doctor’s Information 2. Patient’s Information 3. Jury Duty Information 4. Medical Reason for Excuse 5. Duration of Excusal 6. Additional Comments 7. Signatures and Acceptance 8. Declaration and Signatures
PDF
WORD
Google Docs
Excuse From Jury Duty Letter From Doctor Template Printable | Editable FormPrintable
