Arizona State Immunization Information System (ASIIS) Opt-Out Forms

forms, health freedom, informed consent, patient advocacy, patients, school issues

The State of Arizona requires providers to submit vaccination data for inclusion in the Arizona State Immunization Information System. This information may be available to health care providers, parents and child care workers. Use the forms below to opt out of having the State of Arizona track your (and your children’s) vaccinations.

ASIIS Withdrawal Request Form (Children)

ASIIS Withdrawal Request Form (Adult)