A permanent medical excusal form - Escambia County Clerk 2026

1. Click ‘Get Form’ to open the permanent medical excusal form in the editor.
2. Begin by entering your name, juror number, and address in the designated fields. Ensure that all information is accurate to avoid any delays.
3. Fill in your report date, which is crucial for processing your request on time. Remember, this form must be submitted five business days prior to this date.
4. Provide the name, address, office phone, and fax number of your healthcare provider. This information is necessary for verification purposes.
5. In the section regarding the medical condition, ensure that it clearly states why you are unable to serve. This must be completed and signed by a physician or nurse practitioner.
6. Finally, have your healthcare provider sign and print their name along with their Florida license number and date. This validates your request for a permanent medical excusal.

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