New Mexico families request a medical or religious exemption from school and daycare immunization requirements by filing this notarized certificate with the Department of Health. For a medical exemption, the parent attaches a certificate or affidavit from a licensed physician, physician assistant or certified nurse practitioner stating that required vaccines would seriously endanger the child's life or health. NMDOH reviews it and returns an approved copy.
The parent or guardian completes the certificate and signs it in front of a notary. The clinician's part is the attached medical letter or certificate from a licensed physician, physician assistant or certified nurse practitioner.
Download the current version from the source each time; forms change without notice.
Certificate of Exemption from School/Daycare Immunization Requirements
Certificate of Exemption from Immunization (Spanish)
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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Under NMSA 24-5-3 and 7.5.3.8(A)(1) NMAC, the attached certificate or affidavit from a licensed physician, physician assistant or certified nurse practitioner must state that the child's physical condition is such that the required immunizations would seriously endanger the child's life or health.
An approved certificate is valid for a period not to exceed twelve months and then expires. To continue the exemption, the parent completes a new notarized Certificate of Exemption, with a new medical letter for medical requests, and seeks approval again.
Yes. NMDOH posts English and Spanish versions. Either way, the parent or guardian must sign in front of a notary public, who signs and seals it the same day, and the original goes to the NM Immunization Program for approval.