Immunization Guidelines in Northern Virginia

PediatriCare of Northern Virginia follows the immunization guidelines recommended by the American Academy of Pediatrics. For descriptions of these vaccines and the diseases they protect against, please visit www.immunizationinfo.org , www.vaccinesafety.edu, or www.immunize.org.

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All parents and patients should be informed about the risks and benefits of preventive and therapeutic procedures, including vaccination. It is a parent’s right to consent to or decline vaccination. Declination often is the result of families misinterpreting information presented by the media and on unmonitored and biased websites. This causes substantial and often unrealistic fears. It is our responsibility to provide resources to our families that promote the health and well-being of a child.

When faced with the decision to immunize a child, the welfare of the child should be the primary focus. As a practice, we strongly believe in the benefit of immunization. We understand that there are families that wish to defer immunizations, follow an alternative vaccine schedule, or decline vaccines entirely. In that case, our policy is to have the parent read and complete the AAP Refusal to Vaccinate form.

The sole purpose of this form is to acknowledge that you are exercising your right of “informed consent”. Also, that you have had the opportunity to express your concerns and have any questions addressed. It is our responsibility to acknowledge in writing that you have been provided information and the forum to ask questions.

Immunization Refusal Form – English

Immunization Refusal Form – Spanish

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