This individual has asked to be excused from jury duty for medical reasons. The Juror Qualification Form is sent to all prospective jurors and is used to help determine whether a person is qualified to be a juror.All excuse requests must be in writing and mailed with the Juror Qualification Form within 10 days of receipt of the summons. Can I be excused because I am in the military? Yes, only if jury service will conflict with your duties. Instructions on how to access and complete the Juror Qualification Form. Please Select a Form Below. To request a medical disqualification, please fill out Part I of this form and have a licensed health care provider complete. Part II of this form. If you are 70 years or older and wish an exemption from jury service, you may indicate this on the qualification form.