Free jury duty excuse letter template 13
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[Physician’s letterhead]

[Date]

Office of Jury Commissioner
560 Harrison Avenue, Suite 600
Boston, Massachusetts 02118
Re:

[Juror Name]
[Juror Badge Number]

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.
Kindly disqualify [Juror Name] permanently from the performance of juror service.
Sincerely,
[Physician’s Signature]
[Physician’s Printed Name]