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Connecticut Judicial Branch – Jury Administration fax number
(860) 263-2770
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Jury Administration
Used for: Medical disqualification from jury service (JD-JA-47) submission
Fax destination details
- Department
- Jury Administration
- Purpose
- Medical disqualification from jury service (JD-JA-47) submission
- Form
- JD-JA-47 — JD-JA-47: Request for Medical Disqualification from Jury Service
- Address
- Jury Administration, P.O. Box 260448, Hartford, CT 06126-0448
- Website
- Visit organization website
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Fill Part I with juror information; Part II must be completed by a licensed health care provider. Fax the completed form to Jury Administration at 860-263-2770, or email to jury.administration@jud.ct.gov, or mail to Jury Administration, P.O. Box 260448, Hartford, CT 06126-0448.
Official form instructions are published as a downloadable file on the organization's website.
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