Doctor’s Note for Jury Duty

Date: [Month Day, Year]

To Whom It May Concern,

This letter is to certify that [Patient's Name] (DoB: [Month Day, Year]) has been under my medical supervision at [Your Company Name] for acute lower back pain. The patient's condition has resulted in significant discomfort and limited mobility, preventing him/her from fulfilling her obligations, including attending jury duty.

Due to the nature of [Patient's Name]'s injury, I have advised him/her to refrain from any activities that involve prolonged sitting, standing, or heavy lifting, all of which are typically required during jury service. As such, he/she is unable to participate in jury duties scheduled from [Month Day, Year], to [Month Day, Year].

The patient is currently undergoing a comprehensive treatment plan, including physical therapy and a tailored pain management program. Please excuse him/her from jury duty during this time. If any further details or confirmation of his/her condition are required, do not hesitate to reach out to my office at the contact information provided below.

Sincerely,

[Your Name]