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.

39 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. Template is above

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

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  13. 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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  14. 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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  15. I cant find the health departments corporation listed States name from Dun and Bradstreet website.

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  16. 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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  17. Or lawfully yours

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

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