Skip to main content
Columbia University in the City of New York
Columbia University
Columbia Health logoColumbia Health

Main navigation expanded

  • Our Services
  • Appointments
  • Health Topics
  • Events
  • Forms and Guidelines
  • Our Organization
  • See All Services
  • What's Open Now
  • Patient Resources
  • Coping Tools
  • Immunization Compliance
  • Top Services
    • Birth Control Education
    • Bystander Intervention-Step UP!
    • Individual Counseling
    • Primary Care
    • Register with Disability Services
    • STI Testing
    • Support Groups
    • Travel Medicine
    • Urgent Medical Concerns
    • Workshops and Trainings
  • Cost of Service
    • Overview
  • Make an Appointment
  • Same Day Service
  • Emergency and After-hours Support
  • Alcohol
  • Body Image Concerns
  • Marijuana
  • Disabilities
  • Other Drugs
  • HIV
  • Insurance
  • Men's Health
  • Mental Health and Well-Being
    • Anxiety
    • Depression
    • Stress
  • Nutrition
  • Physical Activity
  • Well-being at Columbia
  • Relationships
    • Overview
    • Academic Relationships
    • Friendships
    • Roommates
  • Sexual and Reproductive Health
  • Sleep
  • Transgender and Gender Expansive Health
  • Violence Prevention
    • Prevention
    • Consent
    • What Is Sexual Assault?
    • Supporting a Survivor
    • What Is Relationship Abuse?
    • Stalking
    • What Is Sexual Harassment?
  • Women's Health
  • See All Events
  • Columbia Health Flu Season Information
  • Virtual Naloxone Training
  • Immunization Compliance
    • Immunization Requirements
    • Immunization Forms
  • About Columbia Health
    • Who We Are
    • Who We Serve
    • Confidentiality, Patient Rights, & Patient Responsibilities
    • Operating Philosophy
    • Video Library
    • Your Feedback
  • Staff Directory
  • Health Units
    • Alice! Health Promotion
    • Counseling and Psychological Services
    • Disability Services
    • Insurance Office
    • Medical Services
    • Sexual Violence Response
    • Immunization Compliance
Columbia Health logo Columbia Health

You are here:

  1. Home
  2. Forms and Guidelines
  3. Medical Exemption Request Form: COVID-19 Immunization

Medical Exemption Request Form: COVID-19 Immunization

June 28, 2022

View step-by-step instructions.

Download the form:

Request for COVID19 Medical Exemption Form 06.28.22_a.pdf486.3 KB

Document Categories

Forms

Document Topics

COVID-19
Immunization Compliance
Columbia Health Administration Wallach Hall, Suite 125, Mail Code 4202, 1116 Amsterdam Avenue · New York, NY 10027

Phone

212-854-2284

Contact Us

[email protected]

Internal Use Only

Login to Access

Follow Us

Facebook Instagram Youtube
Columbia University Columbia University Logo
©2023 Columbia University Accessibility Nondiscrimination Careers Built using Columbia Sites
Back to Top