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Vaccine Exemption Forms

Professionals for Medical Informed Consent and Non-Discrimination (PROMIC) have supplied vaccine exemption forms that you can download and print or complete online. You can view the original source of these documents here.

Explainer: COVID-19 injections, vaccines or immunisations that have been administered to the public under emergency use authorisations, have been associated with moderate to severe adverse events and deaths in a small proportion of recipients, including children. There are no long-term safety data from Phase 3 trials relating to children, and trials involving children remain limited and in no way are sufficient to accurately characterise either risks or benefits. As the immunisation has been rolled out among young people and children, adverse event data has been accumulating and are suggestive of an appreciable risk. Balanced against this is the risk posed by the SARS-CoV‑2 virus that causes COVID-19 that, presently, appears negligible among healthy children. Individuals with medical concerns, along with those who have already had COVID-19 and acquired natural immunity, have justifiable grounds to not consent to COVID-19 immunisation. Such individuals may employ alternate approaches to reduce both transmission risk and risk of serious disease. UK and international law enshrines an individual’s right to refuse any medical treatment or intervention without being subjected to penalty, restriction or limitation of protected rights or freedoms, as this would otherwise constitute coercion.

Provided by PROMIC.

Exemption Form for your Doctor to Sign

Take this form to your GP and ask that they sign it to validate your exemption on medical grounds.

Self-Declared Exemption Form

Complete and print this form and present it to challenge any discrimination that you receive. If you are under the age of 16, please use this form instead.

Disclaimers from PROMIC:

  • 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. 
  • 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.
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