Tdap declination form 2026

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The document is a Tdap Declination Form for individuals in Southern California, acknowledging the risks of pertussis due to occupational exposure and the decision to decline the Tdap vaccine.

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Click ‘Get Form’ to open the Tdap Declination Form in the editor.
Begin by entering your full name in the 'Print Name' field. This identifies you as the individual completing the form.
Review the acknowledgment section carefully. It outlines important facts about whooping cough and your potential risk due to occupational exposure.
In the signature field, sign your name to confirm that you understand the information provided and are choosing to decline the Tdap vaccine.
Finally, enter today’s date in the designated area to complete your form. Ensure all fields are filled accurately before submission.

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