Do I need a notary for the Juror Disability & Medical Certification Form?

No. The form has signature and date fields for the juror and physician, but no notary block. The physician states that the information provided is true and correct.

How do I submit the Juror Disability & Medical Certification Form?

Present the form to your physician for completion, then return it to Fisher County Jury Services at 112 N. Concho, P.O. Drawer 88, Roby, Texas 79543, within 15 days of notification.

What does the physician need to complete?

The physician describes the illness or disability, checks when the patient may be able to serve or whether they are permanently unable, and signs and dates the form.

Fisher County, TX · Fisher County

No notary required

Juror Disability & Medical Certification Form

Jurors seeking a disability, medical, or mental exemption use this form to provide physician certification to Fisher County Jury Services.

At a glance

Issued by: City of Fisher County · Fisher County, Fisher County, Texas
Notarization: Not required: file this form without a notary.
Official source: fishercounty.org
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

This form supports a juror’s request for a disability, medical, or mental exemption after their questionnaire indicates they might qualify. The juror authorizes release of medical information, and a physician describes the illness or disability and indicates when the patient may be able to serve. Fisher County Jury Services says to present the form to a physician and return it within 15 days of notification.

Who needs it

A juror in deferred status who wants to claim a disability, medical, or mental exemption should ask their physician to complete this form.

How to submit it

Present the form to your physician for completion, then return it to Fisher County Jury Services within 15 days of notification. The listed address is 112 N. Concho, P.O. Drawer 88, Roby, Texas 79543.

About notarization

This document is signed and dated by the juror and physician without a notary; the physician states that the information provided is true and correct.

How to submit this form

1
Download the Form
Download the Juror Disability & Medical Certification Form.
2
Complete Your Section
Authorize release of medical information and fill in your signature, printed name, phone number, and date.
3
Ask Your Physician
Present the form to your physician to describe the illness or disability and complete the certification.
4
Return the Form
Return the completed form to Fisher County Jury Services within 15 days of notification.

Frequently asked questions

Do I need a notary for the Juror Disability & Medical Certification Form?: No. The form has signature and date fields for the juror and physician, but no notary block. The physician states that the information provided is true and correct.
How do I submit the Juror Disability & Medical Certification Form?: Present the form to your physician for completion, then return it to Fisher County Jury Services at 112 N. Concho, P.O. Drawer 88, Roby, Texas 79543, within 15 days of notification.
What does the physician need to complete?: The physician describes the illness or disability, checks when the patient may be able to serve or whether they are permanently unable, and signs and dates the form.

Need something notarized?

This Juror Disability & Medical Certification Form doesn’t need a notary, but Texas residents can notarize other documents online with a commissioned online notary.