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REQUEST FOR MEDICAL DISQUALIFICATION FROM JURY SERVICE 2025

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The document is a request form for medical disqualification from jury service in Connecticut. It requires jurors to fill out personal information and have a licensed health care provider confirm their inability to serve due to physical or mental disabilities. The completed form can be submitted via fax, email, or mail to Jury Administration, which will notify the juror of the decision regarding their disqualification.

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Click ‘Get Form’ to open it in the editor.
In Part I, enter your name, address, and juror identification number. Ensure all information is accurate for processing.
Provide your date of birth and clearly state your claim of disqualification due to physical or mental disability.
Next, have a licensed health care provider complete Part II. They must provide their opinion on your ability to serve as a juror.
The health care provider should select whether you should be disqualified for one year or permanently and fill in their details including name, title, business address, and contact number.
Once completed, save the document. You can then fax it to Jury Administration at (860) 263-2770 or email it to Jury.Administration@jud.ct.gov. Alternatively, mail it directly to the provided address.

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2022	4.6 Satisfied (21 Votes)
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Can anxiety disorder excuse you from jury duty?

Step-by-Step Instructions for Excusal from Jury Service Medical requests must be accompanied by a doctors note that details your condition. Employment deferments must be accompanied by a letter from your supervisor. If you have moved out of state, you must submit a copy of your new drivers license for that state.

Who is most likely to get dismissed from jury duty?

Dear Office of Jury Commissioner: I am a physician treating [Juror Name] for [identify general nature of medical condition - specific diagnosis is not required.]. This medical condition is a permanent medical condition. In my opinion, [Juror Name] will never be able to perform juror service.

How to get permanently disqualified from jury duty?

You may be disqualified from jury service (not allowed to serve) if: You have been convicted in a state or federal court of a crime punishable by more than one year of imprisonment and your civil rights have not been restored.

Can I say I have anxiety to get out of jury duty?

Heres how to proceed: Contact the Court Clerk: As soon as possible, contact the court clerks office for the court where you are scheduled to serve as a juror. Inform them that you are experiencing an anxiety attack and depression and that your therapist has recommended you not attend jury duty.

What is an example of a medical letter to excuse jury duty?

0:31 3:47 You you could be excused. This is especially true if your condition is being treated. And you canMoreYou you could be excused. This is especially true if your condition is being treated. And you can provide medical documentation.

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What medical conditions disqualify you from jury duty?

1:12 3:50 In other jurisdictions. Like Idaho you also need to provide a medical excuse from your physician. IfMoreIn other jurisdictions. Like Idaho you also need to provide a medical excuse from your physician. If you want to be excused from jury duty due to a physical or mental disability.

REQUEST FOR MEDICAL DISQUALIFICATION FROM JURY SERVICE 2025

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Got questions?

Can anxiety disorder excuse you from jury duty?

Who is most likely to get dismissed from jury duty?

How to get permanently disqualified from jury duty?

Can I say I have anxiety to get out of jury duty?

What is an example of a medical letter to excuse jury duty?

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What medical conditions disqualify you from jury duty?

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