Parents
for Vaccine Education UK
ALL
INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS NOT
TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE. THE DECISION WHETHER
OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND IS YOURS, AND YOURS
ALONE.
UK vaccination information Proof Scandals Thimerosal AUTISM
research Polio Challenging
Thoughts
Please write clearly and if necessary use back of page.
First
name of child:______________________
Date
of Birth: _____________
Reason
why child was not vaccinated:_______________________________
______________________________________________________________
General description of child’s health: _________________________
______________________________________________________________
(Child)diseases
already had, severeness of illness and
complications:_____________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
______________________________________________________________
My child suffers from one of the following:
___ Asthma ___ Neurodermitis ___ Allergies ___ Hyper-activity ___POS
other: ______________________________________________________
Who usually treats the child (pediatrician, GP,
alternative practitioner, homoeopath,...)
______________________________
______________________________________________________________
Information on siblings (please give name, age and whether or not vaccinated, and possibly any information on general health):
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
Address
(if anonymous, please give city only!)
Name:_____________________________
Street:
____________________________
City,
postcode: ____________________________
Tel:
________________________
e-mail:______________________
We,
from the Impfkritische Elterngruppe Salzburg (Parent group of those sceptic of vaccinations
in Salzburg) are trying with this questionnaire to find differences of the
state of health between vaccinated and non-vaccinated children in order to be
in a better position to give advice to parents who seek it.
Thank
you very much for your help and the postage! Please send the questionnaire to:
Impfkritische Elterngruppe
Salzburg
