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Vaccination Declination Form

Ensure comprehensive documentation and legal protection with our Vaccination Declination Form template, essential for healthcare providers.

RJ Gumban avatar

By RJ Gumban on Aug 2, 2025.

Fact Checked by Nate Lacson.

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Vaccination Declination Form Template

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Commonly asked questions

A Vaccination Declination Form is a document used when a patient refuses recommended vaccinations. It records the patient’s informed decision and the potential risks of declining vaccination.

The Vaccination Declination Form should be signed by the patient, a witness (preferably a healthcare professional), and the attending healthcare provider. This ensures that all parties acknowledge the discussion and the patient’s decision.

A Vaccination Declination Form provides legal protection by documenting that the patient was fully informed of the benefits and risks of vaccination and chose to decline it. This helps mitigate potential legal claims against the healthcare provider.

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