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Religious Exemption for Influenza Vaccination
Religious Exemption for Influenza Vaccination
Please complete the Religious Exemption form if your strongly held religious beliefs prevent you from getting the flu vaccine.
Teammate Name:
If Atrium Health Employee Contact Telephone Number:
I am requesting a religious exemption from receiving the seasonal influenza vaccine. As described below, my strongly held relgious beliefs prevent me from receiving the seasonal influenze vaccine. Please Provide a statement regarding your request:
I do hereby affirm that the above inforamtion reflects my strongly held religious beliefs and is true, accurange and complete.
I affirm the above information
I do not affirm the above information
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