Vaccination Notice for Physicians

INTRODUCTION to VACCINATION NOTICES (read first)

The pressure (and monetary rewards) has been steadily increasing for physicians to comply with all CDC recommendations. Should your physician request to vaccinate you or your child ask to see the drug company’s package insert (not a brochure or handout) for the product he/she wishes to inject. Tell him/her that you wish to take it home and read it over with your family. Of course, once you read it you will see why so many folks today are saying no to vaccinations and why these inserts are rarely given to the parent or patient. During your next visit politely tell the physician or nurse that you are not comfortable with the vaccine risks.

Many physician offices are now asking parents who wish to protect their children from toxic vaccines to sign a Refusal to Vaccinate document. These physicians have been told that this document will protect them from being sued by the parent should the child come down with the disease the vaccine was supposed to prevent.

DO NOT SIGN the Refusal to Vaccinate document as it can be used against you in court.  Instead tell the physician you have an alternative document that will serve the same purpose and give him/her your Vaccination Notice requesting that it be placed in the medical record.  The ‘same purpose served’ is the reduction of your ability to sue the physician should your child get the disease the vaccine is supposed to prevent.

FILLING OUT THE NOTICE

  • Download the LAWFULLY YOURS pdf guide posted at the bottom of this page and the Word Doc templates for Vaccination Notices are linked right below it. Select the one(s) you wish to use.
  • Items in grey need to be personalized
  • Select son or daughter as applicable
  • Corporate entities need to be in all caps
  • The health department of each state is listed in its corporate name on the Dun and Bradstreet website
  • Sign the notice in red ink and obtain the signatures of two witnesses or one notary

It is essential to read, understand and agree with the notice before you sign and deliver it. 

DELIVERING THE NOTICE
The notice requires little discussion. Just hand it to the doctor or nurse and request it be placed in your (or your child’s) record. Should you be asked where you obtained the notice, simply say from another parent, which is true. Giving more information is not required nor recommended. Citing websites or vaccine aware groups or authors just serves to motivate those in the vaccination-distribution-business to track down and discredit (or worse) the folks that are doing their best to bring good information to the public. The less said the better. Let the notice speak for you.

Keep a copy of the notice for yourself and ask the nurse or doctor to sign “received on (date)” and sign below it. Should the physician or their office be uncooperative let it go. Proceed by sending the notice certified mail – receipt requested – to their office.  In future encounters with the physician’s office just refer to the notice of non-consent that is in your file.

More methods of empowering yourself in our commercial (UCC) legal system can be found in the LAWFULLY YOURS guide.

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73 responses to “Vaccination Notice for Physicians

  1. If the vaccines are so good why is it so many many vaccinated get the disease while those that don’t get your vaccines do. I had current vaccines & still got whopping cough. Don’t force your greedy desires on me & mine. I firmly believe they do more harm than good. Big pharma doesn’t care about the risks, dangers just the almighty dolar.

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  2. I signed a refusal form. It didn’t look like a legal document in the least it was written in a vaccine pamphlet format. How can I legally retract the document fromy file
    ..

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  3. Do you have UK version of the lawfully yours guide? I need to do a letter to my Doctor who wants me to sign vaccination refusal form. Thank you

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  4. Hello I want to know where I can get the vaccine notice pAper where doc signs, please and thank you

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  5. Do you need two witnesses? I have no friends and only my mom is left in my life when it comes to family.

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  6. I went on line and clicked on vaccination notice for physicians, and it kept canceling itself out. How and where can I get a form? Could someone e-mail me one for Indiana?

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  7. Will the vaccination notice be legal in NY state? (We only have a religious exemption law and I am worried that if I mention anything other than religious reasons we may be denied our exemption)

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  8. I’m going for a religious exemption, but the Dr. still wants me to sign the refusal to vaccinate form, can I still hand in this notice? I don’t want to contradict myself.

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  9. The computer cancels it’s self out when I try to obtain a Copy of the physicians notice form. I’m from Indiana, so do I need an Indian form? I will be using this for the doctors office, instead of the refusal to vaccinate form. Could someone please e-mail me a physicians notice form to: originalself44@yahoo.com

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  10. My child did get shots earlier on in his life. My husband had no choice but to give him the polio elPV /IPV and MMR. Now the school is asking by November 28, 2016 we give him 6 other shots of he will no longer allow my kid to attend school. How do i get around this? I live in kansas and my son needs an education, but i dont want my son getting all these vaccinations?

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  11. Template is above

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  12. Is the vaccination notice on this website the only one there is? I do not 100% agree with what it says and am solely looking to rescind my signature on the form I was made to sign. I also don’t want to require them to sign anything should I choose to allow my son any vaccines in the future for any reason so I don’t want this to shoot me in the foot later. Is this exactly the wording needed for this document or are there variations or can I write my own? If I can write my own is there a website to guide me through that?

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  13. I’m confused. That webpage doesn’t answer my questions.

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  14. That’s neither here nor there. I simply need an answer to my questions above. I am needing help with rescinding my signature and getting this form out of my child’s file because at this time I am not vaccinating. I need to have a form I fully agree with or else I am signing a form just like the doctor gave me. So, my question is, is this document a legal binding document or can it be augmented to fit what I believe? Will it still be a legal document if I change anything? Are there other versions of a Vaccine Notice that I can choose from or is this the only one floating around. I’m not here to discuss my stance or where my stance will be in the future. I did not say I was for vaccines or fully against so this is not a discussion for here. If someone has an answer for me that will help protect my son and my family so I can get this form out of my son’s file than that is what I need. Anything else is wasting time and the form is still sitting in the file where they can possibly claim I am being neglectful for not vaccinating.

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  15. Yes, these questions are in addition to what I have read.

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    • It sounds like you have read all of the material explaining why using a legal notice is important. Our legal notice lists facts, not opinions. It has been reviewed and approved by fellows and researchers who work with us. However, to my knowledge there is nothing to prevent you from seeking other strategies.

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  16. I cant find the health departments corporation listed States name from Dun and Bradstreet website.

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  17. I can’t find the link for the vaccine notice. My daughter is about to be 2 months old next month . & they’re trying to give her vaccines.

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  18. Or lawfully yours

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  19. Exactly what I plan on. Can you give an example on the vaccine notice like you did with the letter? And also after the letter is written do I get witnesses and a notary to sign at the bottom of the letter correct?

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  20. Or is the letter or notice the same paper work that I plan on sending.

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  21. I am in Maryland. My daughter’s previous pediatrician has our (religious) vaccine exemption form and refuses to return it without us rescinding our signatures in letter form. I planned on using your form for rescinding the signatures but am wondering if I need the vaccination notice in addition to this, as we are no longer with the same practice? Please advise! Thank you.

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  22. If you have a good doctor well visits are not just to push vaccines. Once my son’s doctor knew we weren’t vaccinating they didn’t ask us to again. But it was very helpful to go to make sure all was going okay and it was not. The doctor helped navigate services for my son for early intervention, developmental evals and OT services as well as feeding therapy. In order to get a lot of these services the places I’ve taken my son to needed doctors notes, visits and referrals as well as letters of medical necessity for treatment in feeding programs for insurance to cover. I understand your desire to not be asked about vaccines but why not find a doctor who will respect your stance so all else can be checked and monitored in case of other needs?

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  23. My son is under 3 so all within the last 3 years.

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  24. My 7 month old has already receive vaccinations. I no longer want to give him vaccinations because I myself has ADHD and now my four-year-old daughter is showing signs of having it herself. A lot of research has shown that the vaccinations could be to blame. Since I am in Ohio will I be able to just refuse future vaccines or would I need to present a form?

    Currently I do not practice any religion but I am baptized as a Catholic I was hoping I could use that to be exempt. I’m not sure what to do in after hours of researching online it is led me to hear.

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  25. Thanks for the information. I have the template adjusted but I noticed there are two places for witnesses to sign. This knowledge is new to my ethnic community and barely anyone of my family member that live near me will agree to these terms with me. Should I go ahead and delete the witness as me and my husband should be enough of a witness. Or is there another solution. My witnesses who would sign this letter don’t live in my same state.

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  26. Hi. I am planning on using the vaccination notice you have on here for my case. Just earlier, I knew I wasn’t supposed to sign the form but I guess, being from another country, I was talked into doing it in another way and easily agreed 😦 the doc said (my son was let go by his ex-ped for not vaccinating and refusing to sign the form). His new doc asked me to not officially sign it with my signature but just to write on the signature line this line. “I, (my name), am refusing to sign this form in any legal sense”. I wanna be okay with what I did, but part of me is uneasy. Should I still rescind that written line? Wrote it exactly like that. Please enlighten me. And its only gonna be well within 72 hrs when i do it tomorrow.

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  27. Brooke Goranson

    My main concern is while traveling. We live out of country and do not vaccinate. My Kids are all super healthy. However I recall talk of stopping people in airports snd forcing VAC’s. Is there any truth to this and if so how can I protect my children when entering the USA?

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  28. I am not seeing the notice to the physicians in the link: https://anticorruptionsociety.com/lawfully-yours/
    All I see is this:
    Letter of inquiry regarding corporate-government rules and regulations
    Corporate-government employee questionnaire
    Debt validation letter
    Vaccination notice
    Letter to school superintendent
    Employee/student/vaccination notice (a)
    Employee/student/vaccination notice (b)
    Smart meter letter to utility company
    Smart meter notice
    Letter to CPS
    Notice to CPS
    Medical Power of Authority (attorney)

    What am I suppose to use?

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  29. I live in Serbia, which is a member of WHO, here they also want us to sign the Refusal to Vaccinate form. Do you maybe have any suggestion or information on how to get the notice which would be valid for Serbia?

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  30. Kathia St Fort

    Hello, I need the school exempt form but idk where to find it.

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  31. So can I write out my own paper with my reasons and choices,have it notarized and use it at school?

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  32. I signed the form 2 times with 2 different Pedetricians and once with the one we have now. Am I suppose to go back to the first two and give each one a refusal notice? I am worried that they won t cooperate with me

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  33. Just reading through… So in number 8 of the form it says state of Ohio in grey. If you change the state, do you need to change the rest of the sentence at all?
    And the note at the bottom… wondering what it means…does that mean they can’t be sued? Or that it protects them from the vaccine companies?

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    • Doctors have been told that if parents don’t vaccinate their children they might sue the physician should the child contract the disease the vaccine was supposed to prevent. The notice should be kept by the physician as reassurance that the parent made an informed decision NOT to vaccinate.

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  34. Jessica Wiggins

    Thank you so much for all of the information you have provided here. Are you able to confirm that the Vaccination Notice combined with the Letter to Superintendent are the proper way to opt out of having my child forced into receiving Tdap (or any other) vaccination(s) in the state of California as of 2017/2018 school year? Also, the link to Dun & Bradstreet website to obtain the information required in the form, has me confused. I went to that site, typed in “California Department of Health” and it gave me multiple options back, but none that specifically said CALIFORNIA DEPARTMENT OF HEALTH.” Thanks again for your help.

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    • There are no guarantees. However, letting the school (state) know that you are unwilling to accept the liability for any harm/injury the vaccine might cause is critical. If they wish to make dangerous vaccines mandatory, then they (not you) can take the liability.

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