Get Immunization Exemption Form Utah

Filling out the Immunization Exemption Form Utah is essential for individuals who have medical reasons for not receiving vaccinations. This guide provides clear instructions to help users complete the form online efficiently.

Follow the steps to fill out the Immunization Exemption Form Utah online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the child for whom the exemption is being requested. This should be printed clearly in the designated area on the form.
3. Indicate the child's date of birth in the specified field. This information is crucial for verifying age eligibility.
4. Provide a certification from a physician regarding the medical condition that necessitates the exemption. The physician must confirm that the condition may jeopardize the child's health or that of a household member.
5. Check the appropriate box to indicate whether the exemption applies to all immunizations or just one specific immunization. If it's for one immunization, please list the immunizations that are included.
6. If the exemption is temporary, indicate the duration of this temporary exemption. Make sure to include any specific circumstances such as pregnancy or long-term illness.
7. The physician should print their name, sign the form, and date it to authenticate the exemption request.
8. The parent or guardian must also provide their name, signature, and the date to complete the form. Ensure that all provided information is accurate and legible.
9. After filling out all sections of the form, review it for completeness. Users can then save changes, download, print, or share the form as needed.

Complete your Immunization Exemption Form Utah online today.