Form F-05102 Wisconsin Immunization Registry Opt-Out Request - Wisconsin

What Is Form F-05102?

This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form F-05102?A: Form F-05102 is a Wisconsin Immunization Registry Opt-Out Request.

Q: What is the purpose of Form F-05102?A: The purpose of Form F-05102 is to request to opt-out of the Wisconsin Immunization Registry.

Q: Who needs to fill out Form F-05102?A: Anyone who wishes to opt-out of the Wisconsin Immunization Registry needs to fill out Form F-05102.

Q: What information is required on Form F-05102?A: Form F-05102 requires the individual's name, date of birth, address, and signature.

Q: How do I submit Form F-05102?A: Form F-05102 can be submitted by mail or fax to the contact information provided on the form.

Q: What happens after submitting Form F-05102?A: After submitting Form F-05102, the individual's information will be removed from the Wisconsin Immunization Registry.

Q: Is there a deadline to submit Form F-05102?A: There is no specific deadline to submit Form F-05102, but it is recommended to submit it as soon as possible.

Q: Can I opt back in to the Wisconsin Immunization Registry after submitting Form F-05102?A: Yes, individuals can choose to opt back in to the Wisconsin Immunization Registry at any time by completing a new consent form.