COVID-19 Vaccine Exemption Template

Vaccine requirement guidelines recognized by the department of health allow for reasonable accommodations and vaccine exemptions due to medical contraindications or religious beliefs. If you are a health care provider, you can speed up the process of providing COVID-19 vaccine exemptions, as well as other immunization exemption requests, using the COVID-19 Vaccine Exemption Form Template from Formsite.

You can be confident that all health information and personal data remains safe and protected. Formsite offers a HIPAA compliant solution, and form links are secured in transit using SSL/TLS. All data is encrypted in storage. It’s easy to embed this exemption form on your website, or you can email it or post it on social media in just minutes.

Formsite forms are mobile friendly, so anyone can view the form with their tablet or smartphone, fill it out, and submit it. Simplify your health care providers’ workflow by enabling optional notifications so someone on staff is alerted when a vaccine exemption form has been submitted.

Formsite’s easy to use form builder tools with drag and drop simplicity allow you to quickly customize our prebuilt form template to meet your needs. Utilize this form for COVID-19 vaccine exemption, then use it as the jumping off point for other vaccine exemptions (e.g. a religious exemption for Rubella, Tetanus Varicella, Diphtheria, or Pertussis vaccines). This form collects essential medical exemption data such as name, date of birth, phone number, contraindications, history of severe allergic reactions, and other medical conditions.

Check out our form sample below.