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

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 basis for my opinion is itemized on Exhibit A, attached hereto, — “Physician’s Basis for Professional Opinion of Vaccine Safety.” (Please itemize each recommended vaccine separately along with the basis 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

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89 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..

    • Stephanie Hacker says:

      I think it’s a brilliant thing of beauty, also, along with the article. I just re-shared it three times in a row on Facebook. The Canary Party (I think “.com”), has a co-founder, (I think her name is Ginger Taylor); and she has a son who is a “walking vegetable”, because of his pertussis booster. (I read the article that she wrote, which was misrepresented; about “why parents are refusing vaccines). At the end of it, she tells ALL about her son. What impressed me, was that their website (I don’t think), has ANY ads!
      God bless you if you follow God, and Best to you if you don’t.
      To our healthy survival,

    • Trese says:

      Dr. Canfield,
      How is it that a child is able to go to school without vaccination? It is required to attend, and therefore forced on our children in order for them to get an education. My son is now 7 years old, he’s received every “vaccine” that we were told he needed since birth. Now that I am informed and aware of the dangers, I would do anything to prevent vaccination of anyone in my family in the future. Please help. What steps can parents take?

      • Stephanie Hacker says:

        Bring a copy of that downloaded and copied form, and hand it to whoever wants to do the “dirty-work”…(: ……
        They in turn will hand it to their superior, and on, and on. I’m guessing they will pretty much be speechless, depending on the type of person they are. If they have ANY defense, they will probably have hidden, or trashed the form, so make sure you have hidden copies. Maybe in a few places. The form is VERY informative, (tells pretty much the WHOLE story), so if you pull out another copy, maybe THAT will stop them. If they have a heart, they might even take the info for personal use, or to try and help others. THAT would be GREAT…(:

      • D says:


        Most states have a form you can fill out, attesting to the state that you morally disagree with whichever vaccines are “mandatory” for attending public schools. Private schools might have different rules/laws they follow but I’m unsure. Research your state laws for more information.

        • Solange says:

          This is changing. Illinois made a change in August 2015 which most people are not aware of. I learned of it preparing to send our grandson to part time preschool. No philosophical exemptions are accepted. It must be a religious exemption,which now requires you to write a paper and attach it to the formal certificate of religious exemption, then get a medical professional to sign the form stating they educated you on the horrible things that will happen to you, your children and all the world population should you refuse to vaccinate the child. The child or children will be tracked in a large database of people who refuse to comply with the mandatory vaccinations. Guess we will be quoting the bible alot in our thesis required to get approved by someone who doesn’t even know us. The people who changed this within the state of Illinois have absolutely no background to make such a law. Sickening and pathetic!

          • jennifer thompson says:

            Don’t send your child to pre-K and home school. Protect them from this medical tyranny.

      • Barbara says:

        Vaccines are not mandatory to go to school. That’s what they tell you to scare you into them. Go to your local health department and get an exemption and return it to the school, they have to let your child attend. Also another way is to homeschool.

        • Margaret Savage says:

          Barbara for the reply and you are 100% correct. Your info is wonderful and I’ve been screamming for years about inoculations, not that any one listens but It helps me know I tried. When My son was to enter K i refused the shots and at that rime they didn’t have a way to stop him even tho they tried to coerce me .. didn’t work. By 3rd grade I did home schooling. Thanks again for reply.

          • Solange says:

            Many states now have statues mandating home schooled families to provide vaccination records. They need to get in every aspects of our business. Not one of the people making these rules could answer 5 simple questions regarding vaccines, yet can mandate what is placed into the bodies of people.

        • Parent says:

          In Michigan the waiver form says this ” By signing this waiver, I acknowledge that I have been informed that I may be placing my child and others at risk of serious illness should he or she contract a disease that could have been prevented through proper vaccination.” If you sign the waiver form given by the health department then you risk losing your children to CPS (child protective services ) If they get sick or someone else does. They do not allow altering of the waiver in any way. I am currently refusing to sign the waiver because it violates the Michigan Constitution, the Bill of Rights, and the United States Constitution. I am in the process of writing to my state government.

          • Karen says:

            I’ve heard that they won’t accept the form if it has been altered in any way but I also read somewhere that there is a legal way to sign the document and add some initials after your name which mean, legally, that you are signing under duress and you do not agree with what you are signing. Are there any attorneys on this site who can confirm this and let us know what those initials are? I believe it is a latin phrase and that is why the initials are used.

          • Parent says:

            Hi Karen,
            In Michigan you are forced to sign a waiver without altering (crossing out) the form. You can however write in the margins and write above and below a paragraph using an asteric (*). If you place three dots infront of your name it means you want to say something but cannot. You can place V.C. ( Vi Coactus) infront of your name as this states you are signing under protest/duress. Duress because you are being threatened with the school not allowing your child to attend unless you sign. some people go so far as putting a box around their name which means they are agreeing to what is in the box. I put an asteric next to the sentences I didn’t agree with then wrote that I did not agree with that sentence or that statement. I also put three dots in front of my name. looking back on my experience I would have done all of the above just to cover my tail end. The wording in the waiver states that “I understand that I am putting my child in danger” well That opens up the possibility for CPS to nock on my door. I won’t sign for that or agree with that one!!! I don’t even think what they are doing is constitutional but finding how to stand up to the government is scary and difficult!

          • Terri says:

            I know there has been a lot of controversy regarding the link between vaccinations and autism. My grandson is on the autism spectrum. When my daughter took him to his pediatrician for his MMR vaccination, she knew there was something different about him after she got him home. He was just starting to say things like “mama” and “dada”. That ceased immediately. He just stopped developing like children normally do. Mother’s are VERY intuitive when it comes down to their children. By connecting the dots, I find it very hard not to make the connection between the two. I know she feels very responsible for what happen to my grandson. She recently told me she signed a waiver before the vaccinations were given. I don’t know what the waiver is all about so I can only guess it is a consent form that states the risks involved. Can anyone answer that question?

        • Erika says:

          In some states, it is mandatory. I live in California, and without allowing people to vote on it, they just passed a law only allowing medical exemptions. Many people are being forced to either vaccinate or home-school. I am in the thick of it as my children are not vaccinated and I am trying to figure out a way to get them a medical exemption. Our country is losing freedom and this is a big step the wrong way.

        • Jackie Horton says:

          They are mandatory now in Cali and even in the UC system starting fall 2017…NO religious or philosophical exemptions allowed….the heat has been turned up via SB277 passing recently 2015. We need to fight back! My unvaxxed daughter will have to go to college out of state!

      • jennifer thompson says:

        Trese, it depends on the state you live in. The state I am in has a medical exemption, philosophical exemption, and religious exemption. Of course all schools will tell you that you have to have your child up to date to attend. We have 4 sons, all of whom had vaccines until our youngest was injured and I started researching and learning. 3 are in college now, only one in high school. For the last 14 years, at the beginning of school I bring my notarized letter stating it is against my philosophical beliefs, along with the state statute stapled to it. They never say a word to me.

      • Amanda says:

        Its called a religious exemption form.. The state provides them. My children all have one

      • Harvey Wysong says:

        HOMESCHOOL. For heaven’s sake, you can see what monsters are running the government schools. Why would you even think about turning your children over to them for 6 or 8 hours a day for up to 14 years of their lives? Please, please, please, do anything and everything you can to protect your children from not only vaccines, but also the brainwashing by so-called educators. It may require lifestyle sacrifices, but it will be worth it. You will have a closer bond to your children; they will have a secure family identity; and they should emerge with a better education. Friends of mine bought land outside the city, put a double-wide mobile home on it, and homeschooled their six children. One of their sons graduated second in his class from a military academy. Please, examine all your options to see if you can’t homeschool.

        • Solange says:

          Many states have changed this and require vaccinations even for homeschooling. Illinois changed the rules in August 2015 without most people being aware. Our previous relgious exemptions are no longer valid and now requires a new form, a medical professional’s signature, and you must write a document regarding your religious basis. Someone must “approve it”. What a bunch of crap! People who have no knowledge of the facts, and don’t know us will decide if they can legally poison our children? BS

      • brad says:

        The form is a wonderful thing. Give that a try – you show willingness – but put any damage on the shoulders of the schools and they know vaxassination isn’t that great.

        When we homeschooled in the 80s – a shorter version of this in which the school system accepted life-long financial responsibility to pay for all medical costs incurred from the vaccines was used – literally millions of times – and never signed.

      • Noelle says:

        I just signed a waiver with the health department on a personal exemption. You can also claim that is against your religion and in most states they have to allow your child to attend school, they just have to remove your child if there were to be an outbreak of vaccine preventable diseases, which if there were an outbreak in the school I would assume you wouldn’t just send your child anyway, but great they will inform you of any reports of the disease and I believe that is state wide. Look into your states exemption requirements.

        • Solange says:

          Each state is different and many are changing the requirements and access to exemptions. Illinois just changed theirs August 2015 very quietly and under the radar. Scum bags making rules when they know absolutely nothing about the topic they are mandating. What gives them to right to mandate poisoning our children?

    • Leann Wurtzinger says:

      Are you a physician or know a physician who would write a letter stating what you have stated? Or provide a letter from a stating that they do not recommend vaccinations or that it is ok in their opinion not to vaccinate a child or that it is in the childs best interest not to be vaccinated?
      The GAL in the case is refusing to consider any of the information i provide even if it is written by a physician or is cited with research from a physician. She is stating that it is all hearsay.
      I even tried to use the form and state I will be alright with vaccination if a physician would sign this form. And still getting no where so far. Court is next week tuesday and i’m not looking for legal help just a physician to back up that vaccines are not good.

      • Marci says:

        I see this is a new comment. I’m curious to hear more about your situation. Are you going to court over not vaccination?! If so, what state and why? I have a 7 month old and am choosing not to vaccinate. It is my choice right now, but I’m getting nervous as California has recently passed that mandatory law for school and I know people have tried at least taking early steps here in Washington state to pass similar laws.

    • Cheryl says:

      Wish our family had done our homework. Of myself and my six siblings, FOUR of our grandchildren have been diagnosed with Autism or Aspbergers. TWO were born in 2001 on opposite sides of the U.S. One was born in 2009 and one in 2011. It’s terribly sad. The one in CA is the worst with Autism. The other three were all born in and LIVE in the same city in Ohio. My daughter’s two children no longer get the vaccines. My grandson did not get the MMR shot or anything after that, especially after his doctor lied about a previous shot that she said he’d already received and didn’t tell us this was a combo shot with SIX vaccinations. We changed doctors immediately after that for him. His sister, with Autism, was going to a different Pediatrician and he is sympathetic to what’s happening in the family. He does, however, admit that he is bound to be in 90% compliance in giving vaccinations in this country. Something VERY odd about getting FOUR kids on the Autism Spectrum born since 2001 (two of them in 2001) … and the shots with mercury were STILL on the shelves at that time. There’s an interview with Robert Kennedy, Jr. who did investigations into the vaccination/autism connection that is very informative to watch. Google it.

    • M Leinberger says:

      Dear Dr Canfield, is there any way you could forward your research to me? I am having my first baby in a month and am trying to convince my partner and his family (all doctors) that I don’t want our child vaccinated. If you could help by sending me a folder of research, it would help me so very much – since I’m a working mum and even finding the time to research and find articles doctors will credit is quite a challenge…

      My email is mleinberger@gmail.com

      Thanks in advance! Mary

  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.

    • Maja Stefanovic says:

      You are fabulous! Thank you very much

    • Solange says:

      I have known people who have taken this letter to their pediatrician, and every single one of them has been kicked out of the doctor’s office and told not to return.

  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.

  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.

  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.

    • Stephanie Hacker says:

      Canaryparty.org; co-founder Ginger Taylor’s son (she describes everything that happened to him at 18 months), at the end of the article titled, “Canary Party Co-Founder Ginger Taylor’s Op Ed on Why Parents Are Refusing Vaccines”). He is a “walking vegetable”, who doesn’t recognize anyone, and she can’t do anything, because since ’86, there has been a law protecting anyone involved, from prosecution.
      We would have to fight the 245 billion dollar profit, “big pharma” industry. Which would be nearly impossible.
      Also, I read that this law was started to cover up something REALLY big, and it was! A flesh-eating drug, (or vaccine). I’m not sure of the details, and I haven’t proof or anything with which to back up this story; but my point is, they probably covered ALL their bases.
      Anyway, if you pray, this might be your only option.
      All the best, and to our healthy survival.

  24. Lyn D. says:

    http://www.vaclib.org/exemption.htm Find your state and all the exempt forms you need for that state can be printed off for schools and medical offices.

  25. Judith Hogg says:

    I live in Australia and as I would guess many of you know of the horror which is about to visit us, on Jan1 2016, of mandated vaccines with the withdrawal of Family tax benefits and daycare funding. Amounting for some families to AUD 15,000 for one child. The less financially well off will be punished punitively for their desire not to vaccinate, so many rely on help from the Government. Many folks in this category do not wish to have their babies vaccinated but have little choice. The wealthier, can manage without government assistance, the lowest rate of vaccination is amongst these folks, in Oz. It is class discrimination which causes many great concern.
    We have no vaccine damage compensation in this country so Big Pharma can please itself.
    Would this form be of value, maybe some one reading this page might know.

  26. Judith Hogg says:

    The only exemption which is available is on medical grounds, no religious or conscientious objection permitted.

  27. Sarah says:

    Can I request that you make a small change?
    Just in regards to the section where the doctor has to sign to agree that there is no tissue from aborted babies in vaccines. It isn’t tissue. It is cellular protein and DNA. Doctors who justify the exploitation of aborted babies in vaccines, will have no trouble signing it because they will just claim there is no actual tissue.
    But other than that its great 🙂

  28. Leann Wurtzinger says:

    I am looking for assistance for a family court case with my 4 year old son. It was agreed upon before my son’s father and I split up not to Vaccinate any further. I even have a Vaccination record from before I moved out where it states at the top not to vaccinate our child. Now 3 years later after he is married he has tried to hide doctor appointments and set them up with his step son who is 6 months older and have his wife take our child and him not even attend. I’m fighting this in court and need any assistance to help win against the court forcing me to vaccinate our child. lwurtzinger@gmail.com is where I can be reached. Thank you for any assistance that is offered.

  29. Brett Moore says:

    The stupid argument is that the government has a legal obligation to PROVE all consumables are safe. They have NOT proven vaccines are safe, they state all the ingredients are unsafe separately. They try to debunk Autism but ignore a 20 thousand fold increase in autism in only 25 years. I mean.. truly how stupid must you be. People who ask for proof will ignore any proof you give them so what is the point.

  30. Leann Wurtzinger says:

    Are you a physician or know a physician who would write a letter stating what you have stated? Or provide a letter from a stating that they do not recommend vaccinations or that it is ok in their opinion not to vaccinate a child or that it is in the childs best interest not to be vaccinated?
    The GAL in the case is refusing to consider any of the information i provide even if it is written by a physician or is cited with research from a physician. She is stating that it is all hearsay.
    I even tried to use the form and state I will be alright with vaccination if a physician would sign this form. And still getting no where so far. Court is next week tuesday and i’m not looking for legal help just a physician to back up that vaccines are not good.

  31. Margaret Savage says:

    This is wonderful. And another source is Health Ranger. I’ve lost the web address but I do get e-mails from him and they are full of information on vaccines, He has done a lot of research and always puts references at end of articles. I didn’t vaccinate my child and he was healthy all through growing up … until he went into the service and as someone said they get multiple inoculations. His health has turned for the worse. It’s heartbreaking to see it.

    • Brett Moore says:

      I am a nurse and used to accept the free vaccinations that came with a lollipop two girls with a trolly pushed around. I would always without fail fall ill and need days off work in a few days of the painful jab, then catch the flu seriously several times a year, as well as falling ill to just about anything and everything. I stopped that over 8 years ago now. I am surrounded by sick vaccinated nurses but I myself never fall ill, or I get symptoms similar to a mild allergy from a few hours to a day at most, then gone. This supports research which demonstrated vaccinated people not only catch what they are supposed to have IgM immunity against, but they suffer significantly worse clinical symptoms. For those that are not up on immunity, IgM is immunoglobulin memory cells produced when you are exposed to something. Your immune system supposedly takes a few days to react to a new threat, but creates a memory cell so next time it meets a matching threat, it can react immediately. Clinical and sub clinical refer to whether you show signs that you are fighting an infection or whether your body is doing it so effectively you are unaware.

      from all my research study and observation, I am of the premise that the less foreign material we place into our body, the healthier it is. I think it is that simple !

      Brett Moore RN

      • Margaret Savage says:

        Thank you for your comment and you re correct. It’s hard to believe people are so brainwashed they don’t even search out something before they inject into their children. So disgusting.

  32. Brett Moore says:

    It’s not just children. I find the Pro vaxers are as passionate about vaccines as are 15th century religious nuts looking for witches to burn. They will not accept any evidence to counter the propaganda for pro vaccination. They routinely fall back on the small pox study argument in the USA refusing to acknowledge Europe had to vaccine program but also eliminated smallpox (Natural burnout). They adamantly refuse to believe any link between vaccines and Autism but seem unconcerned that Autism (which is brain damage) grew 20 thousand fold to a statistic of 1:8 now, in less than 25 years. And it is nurses, doctors, mothers, people on the street and even people in the Activist group Anonymous who will defend vaccines. I do not understand how the evidence can be rejected and people be unconcerned. Further, even if we had no vaccines at all.. less people would fall ill simply due to acknowledged and legally compensated vaccine injury alone. I try not to be offensive towards people but when confronted with such sheer stupidity and willingness to accept anything they are told, I am left wondering why people are not still holding onto the belief the world is flat, or that everything revolves around the earth and so on. Even my family members vaccinate their kids and I hold my breath hoping that they do not get converted to Autism because it is only then that parents start desperately looking for a cure… and its hard to reverse brain damage.

    • Margaret Savage says:

      Brett Moore you are so right, and I feel your anguish over family / friends or anyone for that matter that will NOT listen until it is to late and then still can’t comprehend what happened and usually your the brunt of that because they think you must have done something. I am sorry your family/friends don’t believe you mine don’t either.

  33. Leslie says:

    This is so wrong my little girl was fine until the shots at 7 mths when she became a different child – high fevers, hospitals now autistic. Why do the people who make the shot not first have to themselves be injected for a period of one year before mandating others to use their poisonous experiments. Until you are hit you will not fully understand, I wish there were people who could stand up for kids and not be afraid to do it.

  34. S.S says:

    For those asking, many states have a religious exemption form in order to get your children into school…not all do and no they aren’t allowed to ask what your religion is…I do find it amusing everyone there is an outbreak of something the school nurse legally has to call me…every time I ask if patient zero had recently been vaccinated and the answer is always yes.

  35. Victor Talha says:

    COPY this – PRINT it – TRY it – DOWNLOAD IT HERE:

    See for Yourselves if Your doctor stands firm on pushing vaccines onto Your family after signing this! If they sign it!

  36. Harvey Wysong says:

    Dear Dr. Mihalovic,

    In 1999 or 2000 I wrote the first version of the Physician’s Warranty of Vaccine Safety to help a mother, who was being brow-beaten by a pediatrician, who insisted that she vaccinate her youngest child. But her first child was learning disabled, and she believed — probably correctly — that vaccines were responsible for the damage to her first child. Needless to say, the pediatrician dropped the issue like a hot rock when she shoved the Warranty across the desk. That was the beginning of the Warranty.

    In about 2005, my former friend Ken Anderson asked me for a copy of the Warranty. I sent it to him along with a detailed history of its origin. In his efforts to market nutritional supplements to White Identity groups, he sent them my Warranty with his name on it and even included my historical narrative as his own. A friend who works with brain damaged children was the one who told me about the mother who was being browbeaten by the pediatrician, and she has used Google search to keep track of the Warranty as it has spread around the world — India, Australia, etc. She first alerted me to Ken’s misappropriation of my work. And she sent your web site to me today.

    I am not looking for any credit for the work, but I do ask you to remove Ken Anderson’s name from my work. No one needs to take credit for its authorship. It is a self-validating document.


    Harvey Wysong

  37. Teresa says:

    It seems to me that if enough people ask that their doctor or doctors fill out this form and are refused, it might just be the basis for a class action suit that provides grounds to overturn the mandatory vaccination laws. If no one can find a doc who is willing to sign, it could be argued that we are being forced into procedures for our children that no doctors will agree is safe. Especially if you have visited more than one doctor. Take their card and staple it to the form, with an affidavit that this doctor refused to sign.

  38. Queti Knight says:

    I live in the UK and am pleased to say we still have freedom of choice on our medical care here. My family are all unvaccinated and superbly healthy.

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