Exemption Forms

The forms below have been prepared to assist and empower an individual to make a fully informed choice as to whether they want to receive the COVID-19 vaccination. No guarantees are provided as to whether (1) any health professional will accept or sign the form (2) the form will be recognised by any organisation. The forms are not intended to give, nor do they give, any medical or legal advice. If an individual has any concerns about the COVID-19 vaccine or if they are being told or recommended to have the COVID-19 vaccine, they are encouraged to seek independent legal and medical advice.   

Please download whichever form is most relevant for your purposes. The forms are electronically editable as PDF documents, or they may be printed as hard copies and completed by hand.

PROMIC does not take responsibility for identifying doctors or other healthcare professionals who will declare exemptions. This is because PROMIC cannot expose such health professionals that may otherwise be targeted by licensing boards. We strongly advise you approach health professionals in your locality. In the event that your doctor or health professional is not prepared to make a declaration, we recommend you self-declare, which is your legal or constitutional right in most parts of the world.

School Vaccination Letter | Informed Consent (UK) | Children Under 16 | Self-Declared  

Health Professional Declared | Statutory Declaration