Request for Exemption from Immunizations for Reasons of ...
Please print neatly or type the information below EXACTLY as you want it to appear on the “Exemption from Immunizations for Reasons of Conscience Affidavit Form”. Thank you. Texas Department of State Health Services Immunizations Stock No. EF11-13140 Rev. 09/2021 To submit your request online, go to: https://co-request.dshs.texas.gov. ................
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