Vaccination Exemption Based on Contraindications

A Physician’s Permanent Medical Exemption Based on Contraindications to Vaccinations document is  shown below as an image with the actual downloadable document here.  ( Medical Exemption Letter BLANK.pdf (10944 downloads ) )

Please Review the images of the Exemption below:

medex1 medex2 medex3

Please Note:  Some states require their own forms be submitted also. Please do a search on (your state) Vaccination Exemption Requirements.



  1. Dr. Pfeiffer, I am a USMC Veteran and already suffer disabilities from the anthrax vaccine. My shot records were miraculously “lost” and I was made subject to an additional round of the anthrax vaccine shot series. I have since found out this was a trend and we were guinea pigs. Just like agent orange, it’s going to take the government 40 years from inception to officially recognize the anthrax vaccine as disabling through the VA compensation. Please also send me your improved version of Vaccine Exemption. Thank you kindly for your heroic efforts and work. [email protected].

  2. Negative amigo.
    I have been too busy with other endeavors lately.
    I will get to it soon.
    Appreciate the reminder.
    Live long and prosper,

  3. The forms that the STATE uses for Exemptions are for school children exemptions only. Not very useful to adults and/or children that want travel abroad. For that you would need this form above, or a better version. I have a better version that is designed on the World Heath organizations “Certificate of Vaccination”, as available from the US GOV printing office: stock number 017-01-00399-9. There is a place on this card for “contraindication to vaccinations”. This card is the same size as a passport. The good part about using this card is that it is already used by millions of US military personnel, and therefore, already recognized/accepted by custom agents/nazis, world-wide. This is half the battle. My version expands the section for contraindications of this WHO pamphlet/book, as necessary, because there is not enough room to write all the details of the contraindications, that are on Dr. Atkins form. I am finalizing my pamphlet soon and can send you a copy for your consideration and use.


Please enter your comment!
Please enter your name here