Want assurances from your pediatrician about vaccines

Here’s a form designed by Ken Anderson you can give them to fill out -- although there is no physician anywhere on earth who will sign it.

PLEASE NOTE: In addition to the form below, there is a web site VacLib.Org that has compiled information on Vaccine Exemption Forms and Information



Here are Links to Their Information

[AK] [AL] [AR] [AZ] [Australia] [Canada] [CA] [CO] [CT] [DC] [DE] [FL] [GA] [GUAM] [HI] [IA] [ID] [IL] [IN] [KS] [KY] [LA] [Maine] [MD] [Mass] [MI] [MN] [MO] [MS] [MT] [NC] [ND] [NE] [NH] [NJ] [NM] [NV] [NY] [New Zealand] [OH] [OK] [OR] [PA] [PUERTO_RICO] [RI] [SC] [SD] [TN] [TX] [UT] [VA] [VT] [WA] [WI] [WV] [WY]




Physician"s Warranty of Vaccine Safety

I (Physician"s name, degree)_________________________, _____ am a physician licensed to practice medicine in the State of ________________. My State license number is _______________ , and my DEA number is _______________. My medical specialty is ________________________

I have a thorough understanding of the risks and benefits of all the medications that I prescribe for or administer to my patients. In the case of (Patient"s name) ___________________________ , age _________ , whom I have examined, I find that certain risk factors exist that justify the recommended vaccinations. The following is a list of said risk factors and the vaccinations that will protect against them:

Risk Factor ____________________________________________

Vaccination ___________________________________________

Risk Factor ____________________________________________

Vaccination ___________________________________________

Risk Factor ____________________________________________

Vaccination ___________________________________________

Risk Factor ____________________________________________

Vaccination ___________________________________________

Risk Factor ____________________________________________

Vaccination ___________________________________________

Risk Factor ____________________________________________

Vaccination ___________________________________________

Get the full form and more details here

Daniel Silver