Before vaccinating your child or a loved one, simply hand this document to your Dr/Physician the following to sign, don’t for to click like at the top of my page to receive up-dates:

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

* 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

* Hydrolyzed gelatin

* Mercury thimerosol (thimerosal, Merthiolate(r))

* Monosodium glutamate (MSG)

* Monobasic potassium phosphate

* Neomycin

* Neomycin sulfate