Would you be willing to share this form with us? I am always interested in seeing what other offices are using. TIA. -Diane, CNP -----Original Message----- From: [SMTP:] Sent: Wednesday, August 20, 1997 11:53 AM To: Subject: immunization refusal I have a "refusal of immunization" form for the office. It lists each of the immunizations, a brief description of the disease the immunization is designed to prevent, and has a space for the parent to sign & date that they have discussed immunization with the doctor and are refusing immunization for their child against medical advice. They have to initial each of the immunizations refused separately; this allows for the "partial immunization refusal" situation. The malpractice carriers also recommend a signed form for immunization refusal. Fortunately, I seldom have to use it! Linda L. Shaw MD, FAAP Altoona, PA