COVID Vaccine Exemption Form Policy

Jul 31, 2020
Health Library

Introduction to Furstenberg Michael Dr

Welcome to Furstenberg Michael Dr, your trusted dental services provider committed to delivering exceptional care in the health industry. As a leading dentist, we prioritize the well-being of our patients above all else. In light of the ongoing COVID-19 pandemic, we understand the importance of addressing concerns related to the COVID vaccine. Therefore, we have implemented a comprehensive COVID vaccine exemption form policy to provide necessary guidance and support to our patients.

Understanding COVID Vaccine Exemption Form

At Furstenberg Michael Dr, we recognize that individuals may have legitimate reasons for seeking exemption from the COVID vaccine. Our COVID vaccine exemption form allows patients to request an exemption based on medical, religious, or personal reasons. It is important to note that exemptions are subject to review and approval by our medical team to ensure the safety and well-being of our patients and staff.

Medical Exemptions

Medical exemptions for the COVID vaccine are granted to individuals who have certifiable medical conditions or allergies that may pose a risk to their health. Our highly qualified medical professionals carefully evaluate each medical exemption request, considering the individual's medical history and relevant documentation. We prioritize the safety of our patients and strive to provide tailored dental solutions that meet their specific needs.

Religious Exemptions

Furstenberg Michael Dr respects and accommodates patients' religious beliefs and values. We honor requests for COVID vaccine exemptions based on sincerely held religious beliefs and practices. We ensure that the rights and freedoms of our patients are respected while maintaining a safe and healthy environment for everyone.

Personal Exemptions

We understand that individuals may have personal reasons that contribute to their decision to seek exemption from the COVID vaccine. Our COVID vaccine exemption form allows patients to express their concerns and provide necessary supporting details. Every personal exemption request is treated with utmost confidentiality and compassion. We believe in maintaining open lines of communication to address our patients' individual needs.

Process for Submitting the COVID Vaccine Exemption Form

Submitting the COVID vaccine exemption form at Furstenberg Michael Dr is a straightforward process. We have designed it to be convenient and easily accessible to our patients. Here is an overview of the process:

  1. Visit our official website at to access the COVID vaccine exemption form.
  2. Complete all required fields with accurate and detailed information.
  3. Attach any relevant supporting documentation that substantiates your exemption request.
  4. Submit the completed form electronically through our secure online platform.
  5. Once received, our medical team will review your request and promptly communicate their decision to you.

We strive to assess every COVID vaccine exemption form promptly, ensuring that our patients' concerns are addressed in a timely manner. Our priority is to maintain a safe and inclusive environment while upholding the highest standards of dental care.


At Furstenberg Michael Dr, we value the well-being and individual needs of our patients. Our COVID vaccine exemption form policy reflects our commitment to addressing concerns related to the COVID vaccine and providing comprehensive solutions that prioritize both safety and patient care. By offering medical, religious, and personal exemptions, we aim to ensure that our patients feel heard, understood, and supported throughout the decision-making process. Trust Furstenberg Michael Dr to be your partner in oral health, where exceptional dental services meet compassionate care.

Cory Gunderson
Important information.
Nov 9, 2023