The original form has a lot of damging language,
you sign the form and state that you agree you understand
The purpose of and the need for the recommended vaccine(s)
Which obviously you don't agree there is a need for the vaccines, hence the decline.
And you sign your agreement w/the following statements, that in spite of your dr warning you about the risks of not vaccinating, you are going against the drs recommendations,
Nevertheless, I have decided at this time to decline the vaccine(s) recommended for my child, as indicated above, by
checking the appropriate box under the column titled “declined.”
and you go on to agree that you are putting your child and others at risk,
I know that failure to follow the recommendations about vaccination may endanger the health or life of my child and
others with which my child might come into contact.
If it's a liability issue the dr is worried about, then you can add to the bottom of the form that should your child contract a vaccine preventable disease, you will not hold your dr liable.
Changing peds is probably the best idea though. However, I think as a last eye opener for your doc, it might be fun to go in and advise you are rethinking getting the shots, but you want protection should an adverse event occur, and see if the dr will sign the following,
A Statement by the Physician
I have this day (Day)_____ (Month) _____ (Year) _____
administered this medication to a child named
____________________________________.
I have advised the parents that their child is at minimal statistical risk from the vaccination.
I hereby do agree that should the child at any time suffer or develop any permanent condition deleterious or injurious to his/her health as a result of this treatment then I will pay any and all costs relating to the care and treatment of this child for the rest of its natural life. I further agree that if my earnings are insufficient to meet these costs, I will sell my home, my business and all my material possessions to put the proceeds towards meeting those costs.
Name of the medication
____________________________________________
Method of medication: [ ] oral [ ] injection [ ] other ___________
Manufactured by: __________________________
Lot Number: ___________
_________________________________________
Signature of Physician
_________________________________________
Physician Social Security Number
_________________________________________
Witness (Parent or other)
_________________________________________
Attending Nurse
************************************************** **
As far as getting a new doc, you can check out family practice docs, they are not as pressured about the vaccines.
Also, check w/local health food stores and chiropracters for suggestions.