Jury Duty Medical Deferral Request Form

Request Jury Duty Postponement for Medical Reasons

When you've been summoned for jury duty but have a pre-scheduled medical procedure, you need a clear, professional way to document your conflict and request a deferral. This Jury Duty Medical Deferral Request Form provides courts with all the necessary information to evaluate your request for postponement or exemption based on medical necessity.

Who Should Use This Form

This form is designed for individuals who have received a jury duty summons but face a legitimate medical conflict, including:

• Patients with scheduled surgeries that conflict with jury service dates
• Individuals undergoing medical treatment requiring extended recovery periods
• Anyone with physician-documented medical necessity preventing jury participation
• Court administrators managing deferral and exemption requests

What This Form Collects

The form gathers comprehensive documentation to support your deferral request:

• Personal and summons identification information
• Details of your scheduled medical procedure
• Physician statement and medical documentation
• Recovery period and limitations
• Preferred rescheduling timeframe
• Supporting medical documentation uploads

How Paperform Streamlines Court Documentation

Managing jury duty deferrals traditionally involves phone calls, mail correspondence, and paper forms that can delay processing. This Paperform template transforms that experience:

Conditional logic shows relevant questions based on your specific medical situation, while file upload fields let you attach physician letters and medical documentation directly. The professional design ensures your request is taken seriously, and custom confirmation pages can inform respondents of next steps while submissions route automatically to court administrators.

For court systems managing multiple deferral requests, this form captures structured data that's easy to review and process. Use Stepper to automate the workflow: route urgent requests for immediate review, send confirmation emails to jurors, update case management systems, and notify clerks when documentation is incomplete—all without manual data entry.

Secure, Compliant Documentation

Court-related forms require trust and security. Paperform is SOC 2 Type II compliant and GDPR ready, with data residency controls and encryption built in. Your jury duty documentation remains secure throughout the deferral process, and integration with your existing court management systems happens seamlessly through native connections or webhooks.

Whether you're an individual requesting a medical deferral or a court administrator streamlining the exemption process, this template provides a professional, accessible solution that respects both medical privacy and judicial requirements.