This form is provided as a basis to work from. We cannot provide any exemption or legal advice on your behalf and we recommend that you work with your trusted medical doctor, patient advocate, and legal counsel when filling out this form.

ArdisLabs assumes no responsibility for the contents of this document, and its effectiveness. We provide it as a help to facilitate your efforts in standing up against the mandates.

For additional patient advocacy and legal resources please use the links below: