We're changing our website design on 27 August 2017.

Australian Immunisation Register (AIR) - Immunisation medical exemption form (IM011)

Use this form if you are a general practitioner and would like to notify an individual’s vaccination exemption due to a medical contraindication or a natural immunity.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.
We’re testing a new website design. Try it out and tell us what you think. Read more about changes to this site.

Page last updated: 16 August 2017

This information was printed Wednesday 23 August 2017 from humanservices.gov.au/health-professionals/forms/im011 It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.