Certificate Of Exemption From Rabies Vaccine Template
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1
2Chapter 420-4-4, Appendix A
Alabama Department of Public Health
CERTIFICATE OF EXEMPTION FROM RABIES VACCINE
Name of Owner (Print)
Telephone Number
Street Address
City, State, Zip
Animal Name
Sex:
Neutered:
□ Male
□ Female
□ Yes
□ No
Species
Age
Weight
Breed
Color(s)
The animal described above has been examined by me on: _____________ and I have determined that vaccinating
this animal would be medically contraindicated and may cause death due to an infirmity, other physical condition, or
regimen of therapy.
Describe nature and duration of infirmity, other physical condition, or regimen of therapy:
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________
PLEASE NOTE: A reluctance to administer a rabies vaccine prior to the expiration of the previous vaccination will
not be accepted as a valid reason for an exemption because it has not been associated with an increased occurrence of
adverse reactions and is not medically contraindicated.
ADPH February 2010
Page 66
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