Parent Notification and Opt-Out Form

You do not need to complete any form to participate in Florida SHOTS™.

If you include your child’s record in Florida SHOTS, your health-care provider will:

  • Have access to an automated, updated immunization history for your child through the convenience of Florida SHOTS
  • Be able to provide an automated immunization form, needed for school or day care entry and attendance
  • Receive an automated reminder from Florida SHOTS records for immunizations that are due
  • Have an automated notification that your child has experienced an adverse event to a specific shot or that your child has a contraindication to a vaccine

Florida is an opt-out state. If you choose to opt out, your child’s record will continue to be in the registry, but it will not be accessible to anyone but the child’s current doctor. (Your child’s school or any new health-care providers your child sees will no longer have access to the information.) You will have to send a written request to opt your child back into the registry.

Adobe Acrobat Document - PDF 59 KBView Opt-Out Form in English
Adobe Acrobat Document - PDF 160 KBView Opt-Out Form en Español
Adobe Acrobat Document - PDF 183 KBView Opt-Out Form in Creole