Medical Excuse Form - Yavapai County Courts website 2026

1. Click ‘Get Form’ to open the Medical Excuse Form in our editor.
2. Begin by entering the patient's name, date of birth, and address in the designated fields. Ensure all information is accurate for processing.
3. Fill in the Juror Badge Number, state, and zip code. This information helps identify the juror's records.
4. In the section regarding mobility or mental restrictions, provide a detailed description of any conditions that make the prospective juror unfit for service.
5. List specific symptoms affecting the juror's ability to serve and indicate how long these symptoms have been present.
6. Indicate when the individual will be able to serve as a juror again and select their employment status from the options provided.
7. The physician or caregiver must print their name, business address, phone number, and relevant license numbers in the appropriate fields.
8. Finally, ensure that all sections are completed legibly before signing and dating the form to affirm its accuracy.

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