Forms

• PDF [205KB]
  Request for Medical Exemption from Vaccinations PDF [205KB]
  Form 139-M
• PDF [164KB]
  Request for Religious Exemption from Vaccinations PDF [164KB]
  Form 139-R
• PDF [62KB]
  Non-Viable Vaccine Returns PDF [62KB]
  Providers: Should this vaccine be returned or disposed? Check this document.
• Vaccine Wastage and Disposed Form
  Form 132. Please complete this Wastage and Disposed form for any vaccine that is wasted and disposed of by vaccine providers.
• Vaccine Return Form
  Form 131. Please complete this Vaccine Return Form for any vaccine eligible for return by vaccine providers.
• PDF [170KB]
  Vaccine Borrowing Report PDF [170KB]
  Form 1122
• PDF [297KB]
  Temperature Log for Refrigerator PDF [297KB]
  Form 670
• PDF [252KB]
  Temperature Log for Freezer PDF [252KB]
  Form 670F