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Jury Duty Medical Excuse Letter Template
A jury duty medical excuse letter tells the court what a summoned juror’s condition stops them from doing, so it can excuse them, move their service to a later date, or arrange an accommodation. Copy the template, see a juror with Crohn’s disease and one recovering from knee surgery, and check how courts in each place handle medical requests.
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- Two filled examples
Blank jury duty medical excuse letter template
FreeJURY DUTY MEDICAL EXCUSE LETTER [Practice name] [Address] [Phone and email] Date: [Date you sign the letter] To: [The jury office, clerk, or sheriff named on the summons] Re: [Juror's full name] Date of birth: [Date] Juror or summons number: [Number on the summons] Reporting date on the summons: [Date] REQUEST [Juror name] is asking to be [excused from jury service, or deferred to a date on or after a given date, or allowed to serve with the accommodation below]. I support this request for the medical reasons below. The court decides. ASSESSMENT I assessed [juror name] [in person, by video, or by phone] on [date of the assessment], and have [treated them since a given year, or seen them for this request only]. Reported by the juror: [Symptoms or limits you did not see yourself, or none] HOW LONG IT WILL LAST [Permanent or long-term, or temporary: the date you expect them to be able to serve] Next review: [Date, or not planned] WHAT STOPS THEM SERVING [Each limit as function: how long they can sit, getting to court and around the building, hearing, concentration through a full day, how often and how urgently they need a break, treatment on fixed days] ACCOMMODATION [Whether set breaks, a seat near the door or a washroom, an assistive listening device or hearing loop, step-free access, or a later date would let them serve, and which; or: none I know of would be enough, and why] Diagnosis: [Only if the court's form asks and the juror agrees; otherwise delete this line] Not assessed: [Anything this letter does not cover, or none] [Your name, credentials] [License or registration number, and where issued] [Signature] To check this letter: [Practice phone or email]
Use it for
- Excusal for a long-term condition
- Deferral after surgery or illness
- Accommodations so the juror can serve
- Court medical forms and online requests
- Mental health conditions
Two filled examples. Every part, filled in.
Each one follows the template. Use them to judge how much detail every part needs.
Jury duty medical excuse letter: severe Crohn’s disease
Family practice, in-person visit; the same facts go on the court’s medical form
Juror
67-year-old retired bookkeeper, summoned to report on Monday, November 16, 2026. Her juror number from the summons is in the heading, and the letter goes to the jury office the summons names.
Request
She is asking to be excused. We talked about a later date instead, but her disease has stayed active for 2 years despite treatment, and neither of us expects that to change within a year. I support her request.
Assessment
I assessed her in person on Tuesday, October 20, 2026. I have been her family physician since 2014 and share her care with her gastroenterologist.
What stops her serving
By her account, she needs a washroom urgently 8 to 10 times a day, often with only a few minutes’ warning, and most often in the morning. She can’t predict when, so she can’t wait for a scheduled break or stay seated through a session of more than about 30 minutes. Her symptom diary for the past month, which I reviewed at the visit, matches what she told me. She also reports fatigue that keeps her at home most afternoons.
Accommodation
We discussed a seat by the door, breaks on request, and shorter days. In my opinion they would not be enough: she would still need to leave the courtroom without warning, several times in a session. I know of no accommodation that would let her serve.
Duration and diagnosis
Long-term: I expect these limits to last at least 12 months, and I will review her in April 2027. Crohn’s disease is named because the court’s form asks for the condition, and she agreed to share it.
Signed
Family physician, with registration number, signature, and the practice phone for the court to check the letter. Issued October 20, 2026. The court decides whether to excuse her.
Jury duty medical excuse letter: deferral after knee surgery
Orthopedic clinic, post-operative visit; letter for the court’s online deferral request
Juror
38-year-old electrician, summoned to report on Monday, November 2, 2026. He will upload the letter with the court’s online deferral request, which asks for his juror number and a new date.
Request
A deferral of about 3 months, to a date on or after Monday, February 1, 2027. He wants to serve and isn’t asking to be excused. I support the deferral.
Assessment
I assessed him in person on Wednesday, October 21, 2026, 3 weeks after I operated on his right knee on Wednesday, September 30. At his request, the letter says “knee surgery” and gives no further detail.
What stops him serving now
He walks with 2 crutches and can’t yet put full weight on the right leg, and he can’t drive until at least mid-November. He can sit for about 30 minutes before he has to stand and straighten the knee, and he still raises the leg for part of each day to control swelling. He has physiotherapy on Monday, Wednesday, and Friday mornings until mid-January 2027.
How long it will last
Temporary. Once physiotherapy ends, I expect him to sit through a full court day and get to and around the courthouse without help by the end of January 2027. I will see him again on Monday, November 30, 2026.
Accommodation
A later date fits better than an excuse: the limits are temporary, and he expects to serve. Serving in November with breaks to stand would still mean missing physiotherapy 3 mornings a week.
Signed
Orthopedic surgeon, with license number, signature, and the clinic phone for the court to check the letter. Issued October 21, 2026. The court sets the new date.
How courts excuse or defer jurors on medical grounds. Checked October 2026.
Each court system sets its own grounds and process, and a judge, the jury office, or the sheriff decides. These are examples. None of these rules names the profession that must sign; check the summons and the court’s own form, which may.
United States, federal courts
A person is disqualified if they are “incapable, by reason of mental or physical infirmity, to render satisfactory jury service” (28 U.S.C. 1865(b)(4)), decided from the juror qualification form and other competent evidence. Others may be excused for undue hardship or extreme inconvenience, for as long as the court considers necessary, and are then summoned again or returned to the pool, as the court’s jury selection plan provides (section 1866(c)(1)).
California
Deferral is preferred to excusal for a temporary or marginal hardship, and a request to be excused must say why a deferral wouldn’t avoid the hardship. A juror may be excused for a physical or mental disability or impairment, not affecting their competence to act as a juror, that would expose them to undue risk of mental or physical harm. Unless they are 70 or older, they may be required to verify the disability, its probable duration, and the particular reasons they can’t serve. A juror who cares for a sick, disabled, or infirm person may be asked to verify that the person needs regular and personal care.
Ontario
A person is ineligible if they are physically or mentally unable to do a juror’s duties and can’t be reasonably accommodated so that they can (Juries Act, s. 4). A judge or the local sheriff may defer service on the ground of illness, to a later sitting that year or the next (s. 17), and a judge may excuse a summoned person on the ground of illness or serious hardship; the application can be made to the local sheriff (s. 23). The Act prescribes no medical certificate.
Québec
Persons afflicted with an infirmity, or whose health is incompatible with serving on a jury, may be exempted, as may anyone 65 or older (Jurors Act, s. 5). A summoned person may instead ask to serve at a later session within the next 12 months. The request is made on the prescribed form, which is deemed a sworn statement. If the summons came at least 30 days ahead, it goes to the sheriff within 20 days of service, and the sheriff rules on it; otherwise, it goes to the judge before the oath is taken (ss. 29, 31, and 34).
Québec, exemption form
The prescribed application lets a prospective juror ask for disqualification, exemption, or postponement to a later session, and give the grounds. Its notice says to apply within 20 days of receiving the summons and to attach any necessary supporting documents, such as a detailed medical certificate.
Alberta
A person may be exempted if serving would cause severe hardship to their health, or if they have a physical, mental, or other infirmity incompatible with a juror’s duties; so may anyone 65 or older (Jury Act, s. 5). The sheriff decides on an application made in the prescribed manner, with an appeal to a judge. The infirmity exemption doesn’t apply to a person who wants to serve and who, with a person, device, or altered surroundings the court considers adequate, could see and hear adequately and attend court in adequate comfort (s. 6).
What goes in each part.
Juror and summons
Who the letter is about, and which summons it answers, so the jury office can match it to the right file.
- The juror’s full name and date of birth
- The juror or summons number, copied from the summons
- The reporting date on the summons
- The jury office, clerk, or sheriff the summons names
Avoid: A letter with no juror number. The office may not match it to the summons in time, and the juror may still be expected to attend.
Request
What the juror is asking for. Courts treat an excuse, a deferral, and an accommodation differently, and some forms have a box for each.
- Excused, deferred to a later date, or allowed to serve with an accommodation
- For a deferral, the earliest date you expect them to manage
- That you support the request, and that the court decides
Avoid: Writing the outcome as an order, such as “must be excused.” The court decides; you give the reasons.
Assessment
When and how you saw the juror, and how well you know the condition.
- The date you assessed them, and whether it was in person, by video, or by phone
- How long you have treated them, or that you saw them for this request only
- What rests on their own account, labeled as theirs
Avoid: Writing for someone you haven’t assessed, or haven’t seen since their condition changed.
How long it will last
Whether the condition is permanent or temporary. This often decides between an excuse and a later date.
- Permanent or long-term, and why you expect no change
- Temporary, with the date you expect them to be able to serve
- When you will review them
Avoid: “Indefinitely” for a condition that will settle. Give a date, even an estimate.
What stops them serving
What the condition stops the juror from doing, set against a day in court: the journey, long sittings, listening, and deciding.
- How long they can sit before they must stand, move, or leave the room
- Getting to the courthouse and around it: driving, transit, walking, stairs
- Hearing and following spoken evidence
- Concentration, memory, or fatigue over a full day
- How often and how urgently they need a break
- Treatment on fixed days, such as dialysis or chemotherapy
Avoid: A diagnosis with no effects. The court can’t tell from a name alone what the juror can’t do.
Accommodation
Whether a change would let the juror serve. Some places expect the court to consider one before it excuses anyone.
- Breaks at set times, or on request
- A seat near the door or a washroom, or room to stand
- A hearing loop or assistive listening device
- Step-free access or a ground-floor courtroom
- Or that you know of none that would be enough, and why
Avoid: Leaving it out. If breaks or a listening device would let the juror serve, say so.
Signature and verification
Who wrote the letter, so the court can trace it to you and check it.
- Your name and credentials, and your specialty if it matters
- Your license or registration number, and where it was issued
- Your signature and the date
- A phone number or email the court can use to check the letter
Avoid: Sharing more when the court calls. Confirm that you wrote the letter; anything further needs the juror’s consent.
Common mistakes, and how to avoid them.
Deciding for the court
Whether a juror is excused, deferred, or accommodated is the court’s decision. Give your findings and your opinion on what they can and can’t do, and say that you support the request.
A diagnosis in place of function
A diagnosis alone doesn’t show why someone can’t serve. Say how long they can sit, whether they can get to court, hear, and concentrate, and how often they need a break.
An excuse when a later date would do
A condition that will settle in weeks or months usually fits a deferral. Many courts prefer one, and some ask why a later date wouldn’t work before they excuse anyone.
Writing for someone you haven’t assessed
Don’t write from a phone message or a relative’s request. Assess the juror yourself, recently enough to know how they are now, and label what rests on their account.
Missing the court’s form or deadline
Many courts take medical requests only on their own form or online, within a set time after the summons. Check the summons first, and put the same facts in their boxes.
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Frequently asked questions.
What should a jury duty medical excuse letter include?
The juror’s name, date of birth, and juror number; when you assessed them; whether the condition is permanent or temporary, and for how long; what it stops them doing in court; and whether an accommodation or a later date would let them serve. Sign with your name, credentials, and license or registration number.
Can a doctor excuse someone from jury duty?
No. The court, its jury office, or the sheriff decides. Your letter gives the medical facts and your opinion on what the juror can do, and they decide whether to excuse, defer, or accommodate.
Should the juror ask for an excuse or a deferral?
For a condition that will improve, such as recovery from surgery, a deferral to a later date usually fits better, and many courts prefer it. An excuse fits a long-term condition that stops the person serving and isn’t expected to change.
Do courts have their own medical form for jury duty?
Many do, or take requests online through the summons website, often within a set number of days. Check the summons before you write, and use the court’s form when it has one.
Does the letter need to include the diagnosis?
Only if the court’s form asks for it and the juror agrees. What the court needs most is how the condition affects the juror in court: sitting, travel, hearing, concentration, and breaks.
Does every juror need a doctor’s note to be excused?
No. Some places let jurors past a set age ask to be excused without a medical letter, and some courts accept the juror’s own statement for some requests. Ask the juror to check the summons first.
Show all questions
Can I write a jury duty letter for a mental health condition?
Yes, if you have assessed the juror and the condition affects what jury service requires, such as concentrating through long days of evidence, or attending at all. Describe those effects as you would for a physical condition. Not wanting to serve isn’t a medical reason.
Who can write a jury duty medical excuse letter?
The clinician who assessed the juror and knows the condition: often their physician or nurse practitioner, or a psychologist or psychiatrist for a mental health condition. Some courts’ forms say who may sign, so check before you write.
Can I write the letter without seeing the juror?
Only if you have assessed them recently enough to know how they are now; a video visit can be enough for some conditions. Don’t write for someone you haven’t assessed, or at a relative’s request alone.
Is this jury duty medical excuse letter template free?
Yes. Copy it, or download it as a Word or text file. No account needed.
Can Vero write a jury duty excuse letter from my visit?
Yes. Paste this template into Vero, and it drafts the letter from your visit, with the limits, the dates, and the request you discussed. Review and edit it, then export it to PDF or Word, print it, or email it.
More templates, and guides.
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Workplace accommodation letter template
To an employer: what the condition limits, the change that would help, how long, and answers to the employer’s questions.
Pregnancy accommodation letter template
To an employer: the pregnancy-related limitation, the change needed at work, and how long it lasts.
Unable to attend court letter
For a party or witness who can’t attend a hearing or trial.
Vero Documents
Fill a court’s jury medical form from the visit and the chart.
Medical forms library
Official forms, with links and how to file.
Your template. Filled in from the visit.
Vero writes your notes and letters in the templates you choose, so you review instead of type.
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