Refusal to Vaccinate Form - Mothering Forums

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#1 of 3 Old 04-22-2013, 08:44 AM - Thread Starter
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Does anyone have a sample of a refusal to vaccinate form?  I found one on the computer, but I do not like it, it is too harsh.  I refuse to sign the one the doctor has from the American Pediatric Academy.  I was never asked to sign one until my last visit with a new nurse.

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#2 of 3 Old 04-23-2013, 12:08 AM
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Honestly, your best bet is to make one yourself and attach it to a TON of research, and a 1-page summary of the research. The more you have, the better.


When I refused at my last Ped, I brought in over 200 articles and a quick 1-page summary of the research explaining why I was refusing. At the very bottom of the summary page I wrote the below for the doctor to sign, forcing the doctor to acknowledge that s/he was going against the American Academy of Pediatrics policy (they say NOT to drop a child from the practice simply because they're not vaccinating).


"I, Doctor (name), refuse to participate in the care of (name of child) due to the parent/s (name/s)  Informed Refusal to vaccinate. I have read the parents' attached research and have unsuccessfully attempted to convince them to vaccinate the above child. I understand this goes against AAP guidelines "


Congrats to finding a doctor!! I'm having serious problems finding a doctor.


Here's the AAP info about Not Vaxing:

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#3 of 3 Old 04-25-2013, 05:59 AM
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I cross out the parts I don't like and initial.  On the one my ped has, you can cross out enough to make it sound like vaccinating is a bad idea.  ;)  And then I signed it.  Voila!

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Suz, mommy to 2 chess-playing, lightsaber-wielding boys

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