This form is meant for non-Atrium Health employees.
If you are an Atrium Health teammate, use the Vaccine Exemption/Other Form.
Students from non-Atrium Health schools should not use this form. We suggest that these students discuss with their schools whether they can accommodate their religious objection to the COVID-19 vaccine, or a rare medical need for exemption, by securing an alternative location for them to complete their clinicals.
We understand and respect your decision. As part of the new exemption request process, you must first complete an education module. After completion of the module, you will be able to complete and submit your exemption request form with required attachments. Your request will be reviewed and you will receive a response via email.
To access the education module, please click the link associated with your market below. After course completion, note the verification code that must be entered below for exemption form submittal.
