COVID Medical Exemption Request Form

Students with a medical contraindication to COVID-19 vaccination may be granted a waiver from the vaccine requirement. 

Exemption Process

All information is reviewed by Student Health Services’ medical team which includes physicians board-certified in internal medicine, family practice, and infectious disease. Upon review, supplemental documentation may be requested. Only contraindications noted on any future “Vaccine Information Statement” or the current “EUA Fact Sheet for Recipients” pertaining to the relevant COVID-19 vaccine will be considered valid reasons to avoid vaccination, and contraindications to one vaccine type may not be a valid reason to avoid vaccination with all COVID-19 vaccines.

Students requesting a medical exemption are required to submit a completed COVID-19 Vaccine Medical Exemption Request Form to UB Student Health Services. Students will need the assistance of their licensed health care provider in completing the request form. Students with medical conditions may wish to consult with Accessibility Resources regarding reasonable accommodations.

Students who receive an approved medical exemption should be aware that some off-campus placements may have stricter vaccination requirements than the university and do not accept UB’s exemptions. In these instances, students who receive a UB-approved medical exemption may not be able to complete their degree.

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University at Buffalo
4350 Maple Rd
Amherst, NY 14226

Phone: (716) 829-3316; Fax: (716) 829-2564

Form Facts

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Updated: 3/24/2022

Owner: Student Health Services