If Your Doctor Insists That Vaccines Are Safe, Then Have Them Sign This Form – Dr. Dave Mihalovic

By  Dr. Dave Mihalovic May 2, 2012

The average person that consents to a vaccine injection, either for themselves or for their children, genuinely believes it is for the betterment of health. What they are not aware of is that even their doctor is likely unfamiliar with the toxic ingredients contained in vaccines which can immediately begin to degrade both short- and long-term health. If your doctor insists that vaccines are safe, then they should have absolutely no problem in signing this form so that you may archive it for your own records on the event of an adverse reaction.


The reality of vaccines is that they are a far greater risk to human health than benefit and always have been. In fact, two centuries of official death statistics show conclusively and scientifically that modern medicine is not responsible for and played little part in substantially improving life expectancy and survival from diseases in developed nations.

In North America, Europe, and the South Pacific, major declines in life-threatening infectious diseases occurred historically either without, or far in advance vaccination efforts for specific diseases.

Whenever I personally inform medical doctors of these realities, many of them are quite shocked with the data. That’s not surprising considering the fact that medical students are still brainwashed that vaccines immunize which is a myth in itself, since natural or “real” immunity can never be artificially induced by a vaccine.

Other misinformed educators also still rely on the myth of herd immunity which is nothing short of medical fraud. It is a shame and embarrassment that brilliant students are deceptively led down the path of ignorance every single year at prestigious medical institutions in the hopes of obtaining an education. These students then become the physicians of a good percentage of the population.

One of the problems we have in a society filled with misinformation about health, is that people sit on the fence. They want to conform to the societal norms ingrained in our minds about conventional medicine, but they also want to stand up for their beliefs and conscience. These fence sitters are made up of those who understand that current vaccination practices are unsafe, yet somehow also believe you can make vaccines safer or more effective. That is where we have to shift the opinions of those who are on the fence and have them fall off on the side of natural health rather than conventional medicine. See my article When It Comes to Vaccines, Don’t Sit On The Fence!

I have previously written that if your doctor cannot answer these 4 questions, don’t vaccinate. Well, if your doctor does make an attempt to answer these questions and a verbal response and statement is not satisfactory for your own peace of mind, then your doctor should be at least willing to provide you with his or her personal declaration of the safety and efficacy of the vaccines he or she (or attending physician or nurse) is about to inject in your or your child’s body. Effectively, this becomes your doctor’s warranty that the risk factors he or she has identified justify the recommended vaccinations with the benefits exceeding the risks.

Physician’s Warranty of Vaccine Safety Form

The following form was adapted from Ken Anderson’s original. Perhaps you can find a physician that will sign it because I have no record of that ever happening:

Download PDF English
Physician’s Warranty of Vaccine Safety

Download PDF Espanol

Garantia Medica para la Seguridad en las Vacunas


PHYSICIAN’S WARRANTY OF VACCINE SAFETY
I (Physician’s name, degree)_______________, _____ am a physician licensed to practice medicine in the State/Province of _________. My State/Provincial 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 __________________________

I am aware that vaccines may contain many of the following chemicals, excipients, preservatives and fillers:

* aluminum hydroxide
* aluminum phosphate
* ammonium sulfate
* amphotericin B
* animal tissues: pig blood, horse blood, rabbit brain,
* arginine hydrochloride
* dog kidney, monkey kidney,
* dibasic potassium phosphate
* chick embryo, chicken egg, duck egg
* calf (bovine) serum
* betapropiolactone
* fetal bovine serum
* formaldehyde
* formalin
* gelatin
* gentamicin sulfate
* glycerol
* human diploid cells (originating from human aborted fetal tissue)
* hydrocortisone
* hydrolized gelatin
* mercury thimerosol (thimerosal, Merthiolate(r))
* monosodium glutamate (MSG)
* monobasic potassium phosphate
* neomycin
* neomycin sulfate
* nonylphenol ethoxylate
* octylphenol ethoxylate
* octoxynol 10
* phenol red indicator
* phenoxyethanol (antifreeze)
* potassium chloride
* potassium diphosphate
* potassium monophosphate
* polymyxin B
* polysorbate 20
* polysorbate 80
* porcine (pig) pancreatic hydrolysate of casein
* residual MRC5 proteins
* sodium deoxycholate
* sorbitol
* thimerosal
* tri(n)butylphosphate,
* VERO cells, a continuous line of monkey kidney cells, and
* washed sheep red blood

and, hereby, warrant that these ingredients are safe for injection into the body of my patient. I have researched reports to the contrary, such as reports that mercury thimerosal causes severe neurological and immunological damage, and find that they are not credible.

I am aware that some vaccines have been found to have been contaminated with Simian Virus 40 (SV 40) and that SV 40 is causally linked by some researchers to non-Hodgkin’s lymphoma and mesotheliomas in humans as well as in experimental animals. I hereby warrant that the vaccines I employ in my practice do not contain SV 40 or any other live viruses. (Alternately, I hereby warrant that said SV-40 virus or other viruses pose no substantive risk to my patient.)

I hereby warrant that the vaccines I am recommending for the care of (Patient’s name) _______________ do not contain any tissue from aborted human babies (also known as “fetuses”).

In order to protect my patient’s well being, I have taken the following steps to guarantee that the vaccines I will use will contain no damaging contaminants.

STEPS TAKEN: _________________________
_______________________________________
_______________________________________
_______________________________________

I have personally investigated the reports made to the VAERS (Vaccine Adverse Event Reporting System) and state that it is my professional opinion that the vaccines I am recommending are safe for administration to a child under the age of 5 years.

The bases for my opinion are itemized on Exhibit A, attached hereto, — “Physician’s Bases for Professional Opinion of Vaccine Safety.” (Please itemize each recommended vaccine separately along with the bases for arriving at the conclusion that the vaccine is safe for administration to a child under the age of 5 years.)

The professional journal articles I have relied upon in the issuance of this Physician’s Warranty of Vaccine Safety are itemized on Exhibit B , attached hereto, — “Scientific Articles in Support of Physician’s Warranty of Vaccine Safety.”

The professional journal articles that I have read which contain opinions adverse to my opinion are itemized on Exhibit C , attached hereto, — “Scientific Articles Contrary to Physician’s Opinion of Vaccine Safety”

The reasons for my determining that the articles in Exhibit C were invalid are delineated in Attachment D , attached hereto, — “Physician’s Reasons for Determining the Invalidity of Adverse Scientific Opinions.”

Hepatitis B

I understand that 60 percent of patients who are vaccinated for Hepatitis B will lose detectable antibodies to Hepatitis B within 12 years. I understand that in 1996 only 54 cases of Hepatitis B were reported to the CDC in the 0-1 year age group. I understand that in the VAERS, there were 1,080 total reports of adverse reactions from Hepatitis B vaccine in 1996 in the 0-1 year age group, with 47 deaths reported.

I understand that 50 percent of patients who contract Hepatitis B develop no symptoms after exposure. I understand that 30 percent will develop only flu-like symptoms and will have lifetime immunity. I understand that 20 percent will develop the symptoms of the disease, but that 95 percent will fully recover and have lifetime immunity.

I understand that 5 percent of the patients who are exposed to Hepatitis B will become chronic carriers of the disease. I understand that 75 percent of the chronic carriers will live with an asymptomatic infection and that only 25 percent of the chronic carriers will develop chronic liver disease or liver cancer, 10-30 years after the acute infection. The following scientific studies have been performed to demonstrate the safety of the Hepatitis B vaccine in children under the age of 5 years.
____________________________________
____________________________________ _____________________________________

In addition to the recommended vaccinations as protections against the above cited risk factors, I have recommended other non-vaccine measures to protect the health of my patient and have enumerated said non-vaccine measures on Exhibit D , attached hereto, “Non-vaccine Measures to Protect Against Risk Factors” I am issuing this Physician’s Warranty of Vaccine Safety in my professional capacity as the attending physician to (Patient’s name) ________________________________. Regardless of the legal entity under which I normally practice medicine, I am issuing this statement in both my business and individual capacities and hereby waive any statutory, Common Law, Constitutional, UCC, international treaty, and any other legal immunities from liability lawsuits in the instant case. I issue this document of my own free will after consultation with competent legal counsel whose name is _____________________________, an attorney admitted to the Bar in the State of __________________ .
_________________________ (Name of Attending Physician)
______________________ L.S. (Signature of Attending Physician)
Signed on this _______ day of ______________ A.D. ________
Witness: _________________ Date: _____________________
Notary Public: _____________Date: ______________________

=================================================

I’m really anxious to hear back from any readers whose doctor decides to sign this document in an effort to satisfy your peace of mind. I also have lengthy list of legal professionals who are very curious as well.

Dave Mihalovic is a Naturopathic Doctor who specializes in vaccine research, cancer prevention and a natural approach to treatment

Read the article

This entry was posted in The Blog. Bookmark the permalink.

33 Responses to If Your Doctor Insists That Vaccines Are Safe, Then Have Them Sign This Form – Dr. Dave Mihalovic

  1. Dr. Canfield says:

    I would love to see any doctors that signed this as well. I did not have my daughter vaccinated at all. I did about 2,000 hours of research before she was born and had a folder that was a good thousand pages with all of the different medical literature in it. What I found in my research shocked and appalled me. My daughter has never been vaccinated and is in unbelievable health and has a very bright personality. I would do my own homework and research. Do not be spoon fed anything. The truth will set you free. You just have to dig for it.

    • dara says:

      would you be willing to share your info.. electronically? i am pregnant with my first and am just now learning about the dangers of vaccines..

  2. Chris Brown says:

    Thing of beauty!!!!!

  3. Lindsay Richards says:

    As a small time practicing Homeopath, i think I will print this letter off and give it to any of my clients who are sitting on the fence regarding vaccination. It definately will make them think!! I love it! The general public are so blind when it comes to the scary realities of vaccination, and so many of them choose to bury thier heads in the sand about it and just “go with the flow”……I choose not to vaccinate based on my years of study and schooling and clinical experience with vaccine damaged kids.

  4. Can he write one up for pets?

    • Jo says:

      Thanks… I was thinking the same thing. I hate taking my babies to get vaccinated since I don’t believe in them for humans either.

    • Lily says:

      Both my dogs weren’t vaccinated once I got them. One made it to 11 and a half (kidneys failed; thanks commercial dog food), and the other is now 12 and still kicking and healthy. Never been sick, never picked up parvo. I won’t do it ever now.

      I take my dogs to the chiropractor too. If it’s good enough for me, it’s good enough for them.

    • Lindsey Tempest says:

      Rabies is the only federally mandated vaccination for cats and dogs, and the infuriating thing is every county can deem how often a booster is needed. My county says every 2 years yet the county next door says 3…it’s the SAME vaccine. I do think distemper/parvo combo is very important for puppies, I’ve seen too many die of parvo (I run an animal rescue). It’s also been proven that the rabies vaccination provides immunity for 9+ years yet we are required to booster every 2 years!! I no longer booster my own pets and will only vaccinate puppies/kittens upon rescuing. Pretty scary that my own vet will only vaccinate animals in their leg muscle with the reasoning that if/when they contract some form of cancer from that injection, you can remove a limb and live yet if/when cancer forms along the spine it’s fatal. So I guess lesson here, always request that your pet be vaccinated in their hind quarters as opposed to under the neck skin.

  5. Michelle Kraft says:

    This is amazing, and I may have to carry a copy around with me constantly. I’d also be interested in a document for pets.

  6. gangadhar says:

    powerful! must be a real eye opener for the MDs. thanx!

  7. Sam says:

    As a natural health advocate for all ages and for the elderly, and as a licensed medical provider I would not sign this document due to my own ignorance of these many chemicals in possible COMBINATIONS.

    However, in my graduate program one department head and also my advisor/professor and an M.D., advised against some vaccines, and pointed outid they could remove/damage the myelin sheath on nerves and possibly instigate neurological diseases. This prof was ‘discredited’ down the road by his “new wife” and some female professors, apparently. Some “educated” persons insisted he was demented. He lost his post. His lucidity was also apparently questioned by some ‘ethicists’. Since hearing his dynamic and memorable lectures I, along with many others, no doubt, have become more cautious in accepting ‘best practices’ as ‘best practices’.
    In our family we have carefully spread out ‘necessary?’ vaccines for our own children–only one at a time, and months apart! We also have refused many vaccines for ourself!. Pity the military, whom I’ve had to inject with multiple vaccines at once. NO CHOICES FOR THEM once they sign on, it seems.

    Research in America has done a great deal of good. We have cured and healed. But it may be revealed we started some of our own ‘health issues’ by our tampering with kids immunity at an early age! Times not up, not yet–but death happens to all people–and longer life should be possible, perhaps 120 years. If that means long term sickness, longer life isn’t looking so good. Healthy living and healthier lifestyles needs research. Truth frees us. Tell it, practice it–my motto.

    Parents can still choose vaccines — or not, and must take on the role of protecting their own children through private research as needed!

    Until we know what really is the base cause, or until we know and examine the structure of cancer, autism, immune diseases, Alzheimers, etc we must take compassionate care of patient’s current health and THEIR FUTURE HEALTH as well. Long term effects may not be associated with vaccination of infants…and longitudinal studies are time consuming and expensive–but needed.

    Best wishes for telling the truth first, and opinions later!

  8. Margo says:

    Look. The problem is that these vaccines are becoming ” MANDATORY. ” It is NOT a question of whether or not the PARENTS want to give their WWIII Vets ( kids ) a vaccine or not as TELEVISIONS and the STATE ( PROVINCE ) are the REAL Parents these days. Doctors only know what they’ve read in a book. I, personally, have learned MORE from doing my own research on the INTERNET than reading books which have to go through an EDITING process. You can’t believe everything you read. For example, books on WARS are written by the VICTOR. Take 9/11 for example. It was a TOTAL INSIDE JOB, as was the Gulf of Tonkin incident, Pearl Harbor, the JFK Assassination, the BP Disaster etc. 90% of people beLIEve what is written BY the VICTOR when it is clearly BS. Another example would be FLUORIDE which is a POISON. Every dentist I talk to AND their Assistant’s say that ” fluoride is wonderful for children!!! ” Complete lie and lack of education when it is PROVEN to be a carcinogen. Books are full of so much NONSENSE they sicken me. And there is an obvious EDITING process that they have to go through; hence people with DIFFERING opinions never seem to get their book PUBLISHED. Also, another example is the fact that it is written that VACCINES stopped plagues, polio and a whole host of other diseases etc. That MAY be true. HOWEVER, at the same time, toilets and an amazing sewage treatment process was being built across the modern world. -THIS is never mentioned as it WOULD affect the profits of major pharmaceutical companies worldwide…

    • Margo (a different one) says:

      Vaccines being mandatory varies depending on where one lives. I live in California, USA where there are three waivers for families of non-vaccinated children to use (medical & religious which usually require some documentation and philosophical which requires no documentation). I have five completely unvaccinated children and three (four as of Aug) are in the public school system. I just sign a waiver section on the vaccination form and that’s it. For the whooping vaccine that is currently required in middle school, I had to sign a difference, vaccine-specific waiver but even though the school district says it’s a requirement for my child to attend school, it’s really not. There are other states that unfortunately don’t accept all the waivers (and a few that don’t accept any at all) but just because a school or other entity says vaccinates are required/mandatory, that doesn’t necessarily mean they really are. Schools aren’t going to volunteer the fact that there is a waiver but when a parent knows there is and says they will sign that, it isn’t a problem.

      • Ondrea says:

        Hi Margo,
        I am from California as well and I really dont want to vaccinate my son anymore after reading all this. It is so heart breaking knowing that I had a choice in whether or not to vaccinate my son. If you could please help me I really need to know what forms I should fill out and where I can get them to keep my son from being vaccinated. Also where can I pull up and print out information to show the dr’s that this crap is harmful to my child. Thank you and if anyone else can please help me I will be greatly appreciative.

        • Jennifer says:

          You can get the waivers from the school your child is attending. Just ask for it…if there is a nurse, she usually has the forms.

  9. Vasco says:

    It just makes sense that injecting a toxic foreign substance into the body will not improve the health of a person.

  10. Dana says:

    I’ve never had a shot or anything because my mom never believed in getting shots and I’m perfectly fine and this is my first pregnancy and my doctor want me to get a vaccine, but I don’t want all that crap going into my body. Half the stuff I don’t even know what it is, I’m gonna have my doctor sign it.

  11. Kristin Sanchez says:

    I wish someone would come up with a form like this for vets. Over vaccination of pets in this country is ridiculous. And the vets are the ones pushing it.

  12. Veronica Green says:

    I have a question I’ve wanted to ask since the vaccination my son got when he was 18 months old . He now is 32 . When the doctor gave it he ” accidently ” hit my sons left femur & proceeded with giving the injection . My son couldn’t walk for several days after & it was swollen , tender to touch for weeks after . I was concerned & at that time and still am skeptical of vaccinations . In my sons’ 17 th year he developed bone cancer his femur. By his 18th birthday it was confirm , Ewing’s sarcoma , left femur . The vaccination was the triplet ( a cocktail of 3 serums ) . Is it possible if vaccinations penetrate bone tissue , even superficially , can develope into cancers ?
    I do not want too seek any retribution , but hopeful that my son experience can prevent this from happening & shed some light on those who work in this area of medical research. Sincerely , Veronica Green

    • The Refusers says:

      Found a reference for pets, exactly what you are talking about. Vets can be more honest about vaccine adverse reactions.

      Feline vaccine-associated sarcoma – definition of Feline vaccine-associated sarcoma in the Medical dictionary

      feline vaccine-associated sarcoma
      a rare malignancy in cats occurring in sites typically used for the injection of vaccines. There is an often rapidly growing, soft tissue swelling most commonly located over the cervical-interscapular region or thigh, which is a highly invasive tumor, usually a fibrosarcoma. Treatment by surgical resection, radiation therapy and/or chemotherapy may not be successful. In 1996, a Feline Vaccine-Associated Sarcoma Task Force was formed to investigate the condition and to issue guidelines for administration of vaccines and for the management of injection site masses and tumors. A causal relationship with rabies and feline leukemia virus vaccines has been found. Called also feline injection site sarcoma.
      http://medical-dictionary.thefreedictionary.com/Feline+vaccine-associated+sarcoma

  13. Bridget says:

    Thanks for sharing this. My husband and I were just talking about this last night I’m against it he’s for it. He said unless I can show him why I don’t want this for our kids which I need to do more research but this shows my theory right here. If anyone else has more info for me I’d love it!

  14. Nichole says:

    Where are the attachments listed in the document to be signed by physicians? If I’m going to take those to my doctor to sign, and they REALLY read it all the way, they are going to ask where the attachments are… So, where are they?

  15. April Adams says:

    I would have love to have this for my last Pediatrician ( who saw my boys several times) and knew they were Vaccine exempt and WHY! But would not see them for Physical unless I let Her ( or Husband) Vaccinate! Her quote: They will not come in here without Vaccination, but has seen them for a year and a half Prior! Her Profit Matters to her! SHE IS A SELLOUT! I found a better Doctor!!!!!!

  16. Lori says:

    If this document is to be presented to a Doctor to sign the typos should be corrected if it is to be taken seriously. The word BASES is used several times when the word BASIS should be used. This makes the document look like a joke. I realize this do doesn’t change the facts on vaccine safety but when you’re up against the establishment all the I’s should be dotted and T’s crossed.

  17. Tracy says:

    Thanks so much for sharing this!!

  18. Trista says:

    My husband and I have been going back and forth on whether to continue to vaccinate our children (7yrs and 9 months) as well as any future children, this article really just made my decision for me! Thank you for posting this, I am printing a few copies of this in case any doctor either for my children or myself believes that vaccines are 100% safe to give. Thanks again for taking the time to post this!

  19. Marsha says:

    I love you guys. Keep up the great work. <3

  20. Lis says:

    I wish I’d found this before I switched to a new pediatrician’s office. I definitely could’ve used this form with our old pediatrician’s office. I wish I’d been more educated before we started vaccinating our kids.

  21. terri says:

    I am so grateful for dedicated doctors and the rare individuals who take the time to bless all of us sheeple. How many things have we believed our great? Not so great horrible country has made of believe they were the government and just here to help! I learned of this many years after I vaccinated my two boys. Once I did learn I refused any future and signed the waiver. The damage was done. My oldest son bless his heart was an asthmatic and had chronic ear infections to this day hearing trouble and he will be 29 in September. How he suffered and suffered I am so anti American Cabal ran government. I am ashamed of our country and all Cabal pharma, Their AMA, CIA, DARPA ect ect what the Cabal has caused is a nightmare! Thanks again for all your hard work!

  22. Kraka Head says:

    Pure awesome! The only thing that is missing is a statement of guaranteed efficacy based of associated studies. You know, proof that they actually work. Of course that would be a trap because many of us know efficacy studies on vaccines do not exist.

    It would also be nice to have confirmation that they do not include cancer or HIV viruses such as was found in vaccines from Merck and Bayer.

  23. Ashley B says:

    My son who is currently 2 1/2 has not had any vaccines! However, I took him to the pediatrician today and it was documented that at birth he received the hepatitis B vaccine even though I signed the waiver form. I am VERY upset because I signed a legal document against it and then I find out later they gave it anyway. I’ve called multiple lawyers and asked if I could sue and nobody wants to take the case but there were no “damages”. As a parent that is 100% against vaccines and the toxins they contain I consider the vaccine damaging even if he had no side effects. If only there was a doctor on my side that could defend me and show proof that vaccines are in fact very damaging.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>