Form 3231-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the child's name in the designated field, ensuring you follow the format of last name first.
3. Fill in the birthdate and date of expiration using the provided date fields. Remember to include month, day, and year.
4. Complete the required vaccines section by checking off each vaccine that has been administered. Ensure all dates are accurately recorded.
5. If applicable, provide information for any medical exemptions or natural immunity by filling in the relevant boxes with appropriate dates.
6. Finally, have a licensed physician or health department representative certify the form by providing their printed name, address, signature, and date of issue.

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