Signing the Refusal to Vax Form for Infants

During one office visit when my daughter was about six months old, she was supposed to get her well baby shots.  At that time though, she had had a skin infection, and I felt at that time that I wanted to wait until her immune system was stronger. The photo to the left was from the day of that doctor’s visit. You can see her eyes just aren’t lit up. You can see the infection of her face. You can see that she is not feeling well. I took her to the park to try to get her some vitamin D from he sun to boost her immune system. She usually liked the swings, but on that day, she didn’t have the energy for it.

But I digress…

I had no problems with vaccines at that time. My older children had been vaccinated. I just didn’t want to vaccinate on that particular visit because she wasn’t well.

The doctor said that a skin infection wasn’t a counter-indication for vaccines.

Given that my daughter was consequently on an antibiotic also though,*** (which apparently required her to get her liver tested if she was on it for more than one round) I felt that her body didn’t also need to deal with vaccines at that time.

He disagreed with me.

So, they had me sign a waiver.  I read the part where it said I was knowingly putting my daughter’s life at risk by refusing vaccinations at this visit and questioned him. I didn’t feel I was putting her life at risk. I felt like I was being cautious with her life. I felt that I was protecting her liver. I was planning to go back in a month or so for them. So, I said I didn’t feel comfortable signing that form.

The doctor told me I was required by law to either vaccinate or sign the waiver. As it turned out, that wasn’t actually quite true.  HE is required by law to document the discussion.

So, basically, I was tricked into signing a waiver that I didn’t even agree with.

I guess in some respects that moment ignited all of my vaccine curiosity, because it was the moment that broke my trust in him. I could tell he was lying, but I had no proof. So, I signed it. The mistrust he created was the first big factor that made me more deeply investigate vaccine issues.

I did go back a couple months later and got another round of shots, which she had a reaction to as it turned out. Her entire torso became inflamed and red with a sand paper rash. That was a couple of years ago, and I have since decided to delay vaccinations until she’s older. Possibly indefinitely, but I’m crossing that bridge when I get to it. It will depend on her individual health needs. For now, she has been to an allergist and has confirmed allergies to eggs and peanuts. Latex may be a factor too. We don’t know, there’s still many allergy tests to go. For now, her new pediatrician has said we should not give any more vaccinations at this time.

Her new pediatrician has never even mentioned a waiver to me. I suppose he has other ways of “documenting” our discussion.

Reflecting on her old pediatrician and how he made me feel ignorant and negligent for refusing to vaccinate (while my daughter was on strong antibiotics from a skin infection at less than six months old) made me curious.

So, I went searching.

And I found a pdf file assembled by the American Academy of Pediatrics for doctors. (Click here to view the file)

And that’s when I read the part where the AAP says, “This form may be used as a template for such documentation but should not be considered a legal document and should not substitute for legal advice from a qualified attorney.  This form may be duplicated or changed to suit your needs and your patients’ needs.”

Here’s an alternate form you can give them, since all they really need on file is some documentation proving that the doctor discussed vaccinations with you. They probably will refuse it though. In that event, you could sign their form, and write, “Signed under duress.”  That way, it wouldn’t be considered a “legal admission of negligence.”

I don’t know, I doubt it would ever come to it, but I personally don’t want anything out there with my signature on it where I am saying that I’m neglectful, when I was trying to be quite the opposite…. for many reasons…. perhaps the greatest of them being: Principle.


***At that time, I didn’t know about natural supplements (like Oil of Oregano) to try before getting antibiotics.


  1. Bethanie

    Ok. This makes me so angry. I wanted to do an alternate vaccination schedule for my daughter – omitting Rotavirus, IPV, and Hep B until she was school age since she was not going to be in a daycare of any sort. My daughter was born premature and had to do a short stint in the NICU. I had a gut feeling that her immunity was not up to par, and just did not feel comfortable doing more than one vaccine at a time. Even though I did give her a vaccine, they made me sign the form for the vaccines that I chose not to give at the time. I should mention that I am nurse, and this was at the clinic where I used to work. The other nurses railroaded me about not giving the others. I had already seen enough reactions (especially to Rotavirus and Hep B) and done enough research that I knew what I wanted to do to protect my daughter. Naturally they have also been against my choosing to co-sleep and extend exclusive breastfeeding. She has a ton of food allergies and cannot eat much. What she can eat, she eats in small amounts even now because she remembers how sick food has made her in the past. They diagnosed her, without telling me, with failure to thrive – even though she is still gaining weight and thriving just fine. All of this, and more, has broken my trust with doctors. We have since switched to a chiropractor and a more natural/stand-alone pediatric clinic. I hope that we are on the right foot. I should also mention that at the last doctor visit, with the new pediatrician, we also were not asked to sign that waiver. Like you, the waiver was not even mentioned.

    Interesting, to say the least.

  2. So that form they want you to sign is ridiculous. First because it says “…conseqences may include – Contracting the illness the vaccine should prevent… .” Keyword: should. Sure, in a perfect world.

    The second reason it’s utterly stupid is because it says “The outcomes of these illnesses may include one or
    more of the following: certain types of cancer, pneumonia, illness requiring hospitalization, death, brain
    damage, paralysis, meningitis, seizures, and deafness. Other severe and permanent effects from these
    vaccine-preventable diseases are possible as well.” So stupid because guess what? VACCINES CAN CAUSE THOSE THINGS TOO – and in most cases, are more likely to cause them than the actual diseases.

    When’s the last time you heard of someone dying from chickenpox in America? Never, because we know how to bring fevers down now… and we have appropriate access to medical care when it’s necessary.

    Oh and one more thing – your healthy and non-toxin-injected child can be a danger to vaccinated children? HOW IS THAT if vaccines work? What? You have to be a total moron to try to sneak that language in, and you have to be a bigger moron to believe it.

    Sorry. Vaccines tick me off.

  3. Faye

    i feel that is ridiculous! im so sorry you had to deal with people like that. the feeling of inadequacy form the doctors is something i cant stand. i love my sons doctor, but he strongly believes in vaccines. i did not feel there was such a dire need for it at the time. i delayed shots. although i didnt tell them that, at the time i went in for the check up, my son was a bit ill so they said to wait a few weeks for the shots and just call back to make the appointment. i did that… 2 years later. it was a pain getting shots ready in time for school, since he was going to public school, he needed up to date shots. other than that i do not regret my decision and im proud of myself (and you) for waiting till you felt baby is ready.

    childrens liver’s dont fully operate or mature till about 2 years old. WHY are they given such strong shots at a young age i do not understand. my son is happy, healthy, and i couldnt be happier with my decision. dont ever EVER let the doctors make you feel stupid or like you are harming your child. they call it a practice for a reason.

    • Dawn Babcock Papple

      Their brains still have a lot of growing too- mostly done at a year, and then substantially done at three… so, what’s the rush? Agreed. Except now, that I’ve been obviously lied to, I tend to side with Angie that there’s way more too the dangers, an that they want US to be their test subjects. Just like suggesting pregnant women get the H1N1 vax… which I’ve read led to a bunch of miscarriages within two days after. I am looking for non-US friends to find me those links right now, because in the US, we don’t have easy access to a lot of medical journals from other countries easily. We do have access, but links and such will show up empty for us, and my friend in Canada can click through on them. So, I ask for her help to get the real story.

  4. Karen

    The military clinic we moved near when my son was 9 months old didn’t even offer a waiver so I could continue spreading out and refuse a couple of shots. They said it has to be all or nothing, lectured me on how stupid I was for thinking shots have normal shot side effects (not even the small print effects, the large print ones), how dangerous spreading shots out is “He will be behind. He will get sick and die!”, and they couldn’t believe that previously another clinic had no problem with DS getting 1-2 shots per month. Because of THEIR ignorance DS is missing multiple shots I don’t have a huge problem with. All or nothing? I chose nothing. And thanks to their ignorance I researched all of the shots more thoroughly and am not sure about getting the rest of the RECOMMENDED shots. Not even the CDC says they are mandatory shots nor do they say the schedule is mandatory, the schedule just gives the earliest possible age you may give the shots.

    • Dawn Babcock Papple

      They are trained that way and believe they are doing their best. And it may end up being true that they are right… but I just don’t think so. I just don’t think so. I do believe that they think so though and are trained the best way to manipulate us… in the best interest of the child of course.

  5. Tiffany

    I’ve been fortunate to have a great pediatrician (at a military hospital nonetheless!). We’ve delayed vaccines for some time now. They don’t ever question why or lecture me; they will give their concerns, but accept that I’m the last voice. I even witnessed someone breaking up the vaccines in to different visits with no issues.

    It’s a shame that it’s so hard to find this! I wish there were more well informed doctors vs textbook doctors!

  6. Dawn Babcock Papple

    I guess what I don’t understand is if Japan was able to delay vaccines for infants for two decades, and meanwhile enjoyed the lowest infant mortality rate on the planet, why can’t we? I am not in agreement that vaccines are good, but I am willing to concede that for the whole, when taking into account children with immune systems that are compromised and wanting to keep them safe because well, “There but for the grace of God go I.”

    I don’t like overpopulation, sure. I also,however, am too much of a “mom” to accept the whole survival of the fittest mentality, even though it makes perfect (albeit cold) sense. So, I am willing to take my long term chances with vaccines to benefit children who could not withstand a disease coming back. I am not, however, willing to allow my children to be the test subjects at an age that is proven through this new information ( to be unsafe to vaccinate.

    Why can’t we wait until after they are three and encourage breastfeeding to establish good immune systems in the meantime?

  7. christine kangas

    What a horrible experience! I’m so sorry you had to go through that! My son was born a month early and the hospital was pushing us to vaccinate for hep. b while we were there. ALL the babies are supposed to get this vaccination was their reasoning. Okay… but he was a preemie. And you wouldn’t let the cord finish pulsating before cutting it meaning he didn’t get all of his blood…. which would have helped him with his jaundice…. yeah, no. I refused. Our pediatrician is also our family doctor. He asked about the vaccination and I told him we didn’t do it and our reasoning. We wanted him to be healthy before he got the vaccine. He agreed and said that was probably smart. He gave us the okay to vaccinate him for that first vaccine at 2 weeks, when his bilirubin levels were good, he had gained a good amount of weight, and he was healthy as could be.

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