Guidelines for Requesting an Exemption for Medical Need
 

•  To claim an exclusion for medical reasons, the child or student must present a statement signed by the child's physician (M.D. or D.O.), duly registered and licensed to practice medicine in the United States who has examined the child, in which it is stated that, in the physician's opinion, the vaccine required is medically contraindicated or poses a significant risk to the health and well-being of the child or any member of the child's household. Unless it is written in the statement that a lifelong condition exists, the exemption statement is valid for only one year from the date signed by the physician.

 
Medical Exemption Form

Guidelines for Requesting an Exemption for Reason of Conscience
 

• To claim an exclusion for reasons of conscience, including a religious belief, a signed affidavit must be presented by the child's parent or legal guardian, stating that the child's parent or legal guardian declines vaccinations for reasons of conscience, including because of the person's religious beliefs. The affidavit will be valid for a two-year period. The child, who has not received the required immunizations for reasons of conscience, including religious beliefs, may be excluded from school in times of emergency or epidemic declared by the commissioner of public health.
• Written requests must be submitted through the U.S. Postal Service, commercial carrier, fax, or by hand-delivery.

       
Mailing Address:
Immunization Branch
Department of State Health Services
Immunization Branch (MC 1946)
P.O. Box 149347
Austin, TX 78714-9347

Hand Delivery:
Department of State Health Services
Immunization Branch (MC 1946)
1100 West 49th Street
Austin, TX 78756

Fax:
(512) 776-7544

On-Line:
Via the department's online exemption form 
 

• Hand-delivered requests may be submitted to the DSHS, Immunization Branch, between 8 a.m. and 5 p.m. Mondays through Fridays. ALL affidavit forms will be mailed to you via U.S. Postal Service.

Important note: no requests will be filled at the time of hand-delivery.

• Affidavit form requests will be processed and mailed within one week from the receipt of the request. If additional information is needed in order to process the affidavit, you will be notified.
• The letter must include the following information:
  • Full name of each child for whom a form is requested (first, middle, and last);
  • Date of birth of each child for whom a form is requested;
  • Parent or legal guardian's signature and complete return mailing address, including zip code; and
  • Number of forms needed for each child (not to exceed five forms per child)
• Electronic mail or telephone requests cannot be processed.
• The official Texas Department of State Health Services affidavit form must be notarized and submitted to school officials. The form must be submitted within 90 days from the date it is notarized.
• The school will accept only official affidavit forms developed and issued by the Texas Department of State Health Services (DSHS), Immunization Branch. No other forms or reproductions will be allowed.