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Juror Medical Excuse

Medical Excuse From Jury Service form

If a patient requests to be excused from jury service for reasons related to mental or physical conditons, Arizona law requires a written statement from a physician or registered nurse practitioner ("RNP") licensed by the state of Arizona.  If a prospective juror does not have a physician or RNP, a professional caregiver may complete this form.  The Court or Jury Commissioner must deem the professional caregiver acceptable for this purpose.

Some mental and physical problems do not warrant an excuse from service but may warrant a postponement.  For any excuse that you provide, please be aware that you may be called to testify before the court about your representations regarding your patient's inability to perform jury service.  All questions must be answered completely and be legible.  If not, this application will be considered incomplete and invalid.

This document is not a public record and shall not be disclosed to the general public.  A.R.S. 21-202(B)(1)(c)