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The Example Document For Jury Duty Exemption From Physician you find on this webpage is a reusable official template crafted by experienced attorneys in line with national and local laws.
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Any person who is responsible for the care of a person who, because of mental illness, intellectual disability, senility, or other physical or mental incapacity, is incapable of caring for himself or herself shall be excused from jury service upon request.
I am writing to request an excuse from jury duty on the grounds that such jury services would pose an undue hardship on me and an extreme inconvenience to the patients of my dental practice. I am a sole practitioner and have no other dentists in my office who can treat my patients if I am not here.
How: A licensed doctor must complete and submit the Physician Certification in Support of Medical Excuse Request form. You may request an excusal if you care for one or more minor children. There must be no other care available without causing a severe financial hardship.
Excuse from Service You have no means of transportation. You would have to travel an excessive distance to the courthouse. You have a physical or mental impairment. You provide care for a dependent and cannot afford to have someone cover for you. Serving would be an extreme financial burden.