Beginning 09/01/2025, blank immunization exemption affidavit forms may be downloaded from the Department of State Health Services (DSHS) website. The option to request a vaccine exemption through DSHS is still available.

You may request a blank immunization exemption affidavit form by submitting a request through the U.S. Postal Service, commercial carrier, fax, online, or in person. Phone and email requests are not accepted. Affidavit forms submitted through mail, fax or online will be mailed to you via the U.S. Postal Service. Request submitted in person may be picked up same day. The request must include the name of the requester and a complete return mailing address.

Mailing Address:

Department of State Health Services (DSHS) 
Immunizations
MC-1946
P. O. Box 149347 
Austin, TX 78714-9347

Hand Deliver:

Department of State Health Services (DSHS) 
Lobby
1100 West 49th Street 
Austin, TX 78756

Fax: (512) 776-7544

Secure online request form for exemption affidavit:
Affidavit Request for Exemption from Immunizations for Reasons of Conscience
 

Upon receipt, exemption requests submitted through fax, online or in person will be processed and mailed within approximately three weeks. This time period allows sufficient time for mail delivery. Note: you may download a blank immunization affidavit form from the DSHS website at any time.

Information on the form will include a list of required vaccines for which exemptions may be requested; a statement for the parent, guardian, or student, if over the age of 18, stating that the information provided on the form is true and correct and acknowledgement that they have read the attached information entitled The Benefits and Risks of Vaccinations information form. The blank immunization exemption affidavit form must be signed by a notary public.

After the blank immunization exemption affidavit form is filled out, signed and notarized, you must submit it to the student’s school, child-care facility, institutions of higher education, including students enrolled in health-related and veterinary courses.

Each individual blank immunization exemption affidavit is valid for two years from the date it is notarized.

If you lose the exemption affidavit, you may download another one from the DSHS website or submit a new request following the procedures for DSHS to mail you the form.

The blank immunization exemption affidavit is part of the student’s school records and should be sent to the new school with other school records.

All information included in the request for the affidavit that was submitted to DSHS will be returned to you along with the blank immunization exemption affidavit forms. No information will be maintained.

The following requirements must be met for a child to attend school:

1. The student has been immunized in accordance with the rules;
2. The student has an exemption affidavit from immunization requirements on file with the school in accordance with the rules; or
3. The student is entitled to 30-day provisional enrollment.

Yes. A child may be provisionally enrolled for 30-days while awaiting vaccine exemption. Rule §97.66 and Rule §97.69 of the Texas Administrative Code contain the requirements for provisional enrollment.

You will need two different immunization documents: 

1. an official notarized DSHS blank immunization exemption affidavit for those vaccines that you have chosen for reasons of conscience to have your child exempt from; and 
    
2. a valid immunization record indicating the month, date, and year each vaccine for which your child is not exempt and was administered, with appropriate validation by a physician or public health clinic.
    

When you sign a blank immunization exemption affidavit form, you also acknowledge that you understand that your exempted student may be excluded from school attendance in times of emergency or epidemic declared by the Texas Commissioner of Health.

Yes, the vaccinated students may be attending school with others who are not fully vaccinated.

Yes. A child may be exempted from one or more vaccinations for medical reasons, history of disease, or serologic (blood) evidence of immunity.

• Medical Reasons
  • The parent, guardian, or student must provide the school with a certificate signed by a physician (Doctor of Medicine, M.D. or Doctor of Osteopathy, D.O.), registered and licensed to practice medicine in the United States, which states that, in the physician’s opinion, the immunization required would be injurious to the student’s health and well-being or to any of the student’s family or household members. Unless a lifelong condition is specified, this certificate is valid for one year from the date signed by the physician and must be renewed every year for the exclusion to remain in effect.
     
• Serologic Evidence of Immunity to Disease
  • Serologic confirmations of immunity to measles, rubella, mumps, hepatitis A, hepatitis B, or varicella are acceptable. Evidence of measles, rubella, mumps, hepatitis A, hepatitis B, or varicella illnesses must consist of a valid laboratory report that indicates confirmation of either immunity or infection.
     
• History of Disease
  • A written statement from a parent (or legal guardian, managing conservator), school nurse, student over the age of 18, or physician attesting to the student’s positive history of varicella disease (chickenpox), or of varicella immunity, is acceptable in lieu of a vaccine record for that disease. (See form at Documenting History of Illness: Varicella (Chickenpox) — stock # C-9 [PDF])