Submitted by: Nancy Battle
You Want To Vaccinate My Child? No Problem, Just Sign This Form
By: Dave Mihalovic,
Prevent Disease.
Prevent Disease.
I
have yet to meet a Physician that will sign this form now downloaded by
hundreds of parents. The reason they won’t sign is two-fold: First,
they do not want to place themselves in a vulnerable position of being
negligent by not providing informed consent; and second, many of them
realize after their own extensive research that the risks are not worth
the benefits when it comes to vaccination.
It’s
been over a year since hundreds of parents have downloaded this form
and there are still no reports of any signatures. Many physicians won’t
even look at the form while they dismiss a parent’s anti-vaccination
stance as ridiculous. The behavior is a clear indication of a very
misinformed Physician who does not have his or her patient’s best
interests at heart. They are not willing to inform their patients of
the risks, only the benefits they feel are acceptable. They are not
open-minded to any other side of the debate except their own biased
view passed down through the medical system.
Physician’s Warranty of Vaccine Safety Form
The following form was adapted from Ken Anderson’s original.
Then are those Physicians who
have questioned the vaccination schedules and will pursue their own
research. Many of them are now awakening themselves thanks to ongoing
research and pressure from parents and even other colleagues to look at
other perspectives besides their own indoctrination. If you are
pressured by any Physician to vaccinate, please download and print this
form (and send us a Physician signed copy if possible). Assertively
state to your Doctor that it is the only way you will fully informed to
consider vaccination, and that an analyses of the risks and benefits
will better allow you evaluate the decision.
100% of Physicians have so far declined to sign this form. Physician’s Warranty of Vaccine Safety Form
The following form was adapted from Ken Anderson’s original.
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
Download PDF Espanol
Garantia Medica para la Seguridad en las Vacunas
PHYSICIAN’S WARRANTY OF VACCINE SAFETYI (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
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.* 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
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 a 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
Sources :
Read more: http://www.trueactivist.com/you-want-to-vaccinate-my-child-no-problem-just-sign-this-form/
No comments:
Post a Comment