COVID-19 Vaccine Exemption Template

Free trial

In compliance with recognized vaccine requirement guidelines, Formsite offers a COVID-19 Vaccine Exemption Form Template that facilitates expedited processes for medical contraindications or religious beliefs, recognized by the department of health. Here are the main features and benefits:

Key Features:

  • Facilitates Reasonable Accommodations: Recognizes medical contraindications or religious beliefs as valid reasons for vaccine exemptions.
  • Secure & HIPAA Compliance Available: Ensures the safety and protection of all health information and personal data through encryption and SSL/TLS security measures.
  • Versatile Deployment: Easily embed the form on your website, share via email, or post on social media for rapid access and submissions.
  • Mobile-Friendly: Accessible via smartphones or tablets, enabling convenient form completion and submission from anywhere.
  • Workflow Streamlining: Optional notifications alert staff upon submission, streamlining the healthcare provider’s workflow.


  • Security & Compliance: Ensures secure transit and storage of sensitive data.
  • Accessibility: Mobile-friendly design ensures ease of access and submission from any device.
  • Time Efficiency: Quick and simple customization using drag and drop tools streamlines the form creation process.
  • Versatility: Not limited to COVID-19; the form can serve as a foundation for various other vaccine exemption requests.
  • Data Collection: Gathers crucial medical exemption details such as name, date of birth, contact information, contraindications, history of severe allergic reactions, and other medical conditions.


Formsite’s COVID-19 Vaccine Exemption Form Template offers a comprehensive solution that prioritizes security, ease of use, and adaptability, catering to the diverse needs of healthcare providers and patients alike. This versatile template serves as an ideal starting point not only for COVID-19 vaccine exemptions but also for various other immunization exemption requests, streamlining the process and ensuring the collection of essential medical information necessary for exemptions.

Formsite makes building and embedding online forms easy. Whether you need a patient or parent/guardian consent form or a new patient intake template, we can help. We also offer enterprise level solutions for practices and businesses with more advanced form needs. Getting started is easy. Try Formsite today!

COVID-19 Vaccine Exemption Form

Why Formsite

The world-class no-code form and survey builder.

Fully-featured and easy-to-use form builder since



of templates to choose from to get you started

$500 million

in payments processed to date


of forms submitted to date


online form integrations

Customer support based in


Thousands of brands trust Formsite

Be the next one.