For for Physicians Regarding Vaccines

If you are the parent of a little one and feel that you must vaccinate, your child, I encourage you to copy and paste this form into a word document and take it to your child's next well-visit. It is a legal form, much like the one that docs require non-vaxing parents to sign, that indicates that the doctor is guaranteeing that vaccines are safe and that none of the ingredients in them could be toxic. In addition, the form is to be notarized. If you have this form signed, and your child has vaccine reactions/damage, you will at least have somewhere to start with legal action.


Physician's Warranty of Vaccine Safety

I (Physician's name, degree)_____ _________ _________ __, _____ am a physician licensed to practice medicine in the State of ____________ ____ My State 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:
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I am aware that vaccines typically contain many of the following fillers:

aluminum hydroxide
aluminum phosphate
ammonium sulfate
amphotericin B
animal tissues: pig blood, horse blood, rabbit brain,
dog kidney, monkey kidney,
chick embryo, chicken egg, duck egg
calf (bovine) serum
betapropiolactone
fetal bovine serum
formaldehyde
formalin
gelatin
glycerol
human diploid cells (originating from human aborted fetal tissue)
hydrolized gelatin
mercury thimerosol
monosodium glutamate (MSG)
neomycin
neomycin sulfate
phenol red indicator
phenoxyethanol (antifreeze)
potassium diphosphate
potassium monophosphate
polymyxin B
polysorbate 20
polysorbate 80
porcine (pig) pancreatic hydrolysate of casein
residual MRC5 proteins
sorbitol
sucrose
tri(n)butylphosphat e,
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. Reports to the contrary, such as reports that mercury thimerosol causes severe neurological and immunological damage, 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 give my assurance that the vaccines I employ in my practice do not contain SV 40 or any other live viruses. (Alternately, I hereby give my assurance that said SV-40 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 cells 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:
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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% 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% of patients who contract Hepatitis B develop no symptoms after exposure. I understand that 30% will develop only flu-like symptoms and will have lifetime immunity.

I understand that 20% will develop the symptoms of the disease, but that 95% will fully recover and have lifetime immunity. I understand that 5% of the patients who are exposed to Hepatitis B will become chronic carriers of the disease. I understand that 75% of the chronic carriers will live with an asymptomatic infection and that only 25% of the chronic carriers will develop chronic liver disease or liver cancer, 10-30 years after the acute infection. The following studies have been performed to demonstrate the safety of the Hepatitis B vaccine in children under the age of 5 years.
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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: ____________ _________ ___

A special thanks to Vaccine Truth







**Another recommendation, if you intend to vaccinate, is to keep a video journal of your child from month to month, especially video a day or 2 before vaccines, and off an on for the next 2 weeks, making verbal note of any behavioral changes. This way, an subtle differences, or drastic ones will be documented for future reference. It is shameful that we must gaurd ourselves against the very people who swear to first do no harm, but unfortunately when it comes to health care, our country's model seems to be broken. :(