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

Requests for medical exemption will be reviewed by the senior physician, the Infectious Disease specialist, or their designee. 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 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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Health Services

Student Life

University at Buffalo
Michael Hall, 3435 Main Street, South Campus
Buffalo, NY 14214

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