Pdf tennessee certificate of immunization form 2026

1. Click ‘Get Form’ to open the Tennessee Certificate of Immunization in the editor.
2. Begin by entering the child's name and birthdate in the designated fields at the top of the form.
3. In Section 1a, check the box for religious exemption if applicable, and provide the parent/guardian's name in Section 1b along with health examination details if required.
4. Fill out Section 2a with dates for each required vaccine. Ensure accuracy as this section is crucial for school attendance.
5. Complete Section 3 by selecting one of the provider assessment options that best fits your situation, ensuring it is not left blank.
6. Finally, enter the healthcare provider's printed name, address, phone number, and signature in Section 4 before saving or exporting your completed form.

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