Hello everyone! What a terrific response I have gotten for this survey! This IS the 
greatest profession in the world and what a time to show the world what Chiropractic is 
REALLY all about. The immunization and danger issue is something we all should be 
telling our patients and friends about. The more research I dig up, the MORE I oppose it. 
The more I want to shake the parents by the collar and say „look at this¾..this is the damm 
truth¾ !!  I have all of Doc Koren¼s research, Doc Websters material and tapes, all of 
Barbara Loe Fisher¼s and her colleagues work at the Nat Vaccine Info Center and piles of 
„medical¾ research showing the dangers. I have info from the AMA¼s Pediatrician 
Society (these are MD¼s) showing they are highly questioning vaccinations. How much 
more evidence do we need?? AS MUCH AS IT TAKES !! That¼s why I am conducting 
this survey, I want personal testimonials and facts showing unvaccinated kids are 
HEALTHIER than all others. I plan to release a book listing all the people who 
participate in this survey and showing how many kids are „doing just fine¾ without 
vaccinations. And being objective, I will report any problems as well. I am doing this for 
our profession and all the kids that deserve the best healthcare possible.  If you can feel 
the passion in my heart, imagine it 100 times greaterä.that¼s where I stand on these 
issues. What better way to convince your patients then by showing them a book of 
testimonial facts. I think it will be extremely helpful. 

Name (parents)  ________________________________________________________

Address_______________________________ city______________state____zip______

Tel home _______________work_______________parents ages_________________ 

Exemption status in your state  ck ä. () medical  ()religious  () personal

# of children __________  ages  and gender_____________________________

breast fed or bottle _____________________type of formula___________________

list any vaccinations for children (include silver nitrate/antibiotic in eyes at birth) 

___________________________________________________________________ 



______________________________________________________________________




________________________________________________________________________



List any adverse reactions to vaccinations







List any serious illnesses you child/children have








List the #, severity and seriousness of your child/children¼s ear infections








List any of the diseases you child/children acquired naturally (i.e. mumps measles, chick 
pox etc and how they recovered







List any „backlash¾ from medical personal that questioned and/or used „bullying tactics¾ 
on your decision not to vaccinate.









Any additional comments (please speak openingly)













Due to the heavy response of this survey, please print this out on paper, fill it out and 
mail it by stamped envelope to me. My email box will not hold large amounts. Thank you 
and I may have to contact you for more details. And I will keep every one posted (thru 
doc joel¼s column) 

Personally, I am NYCC grad of 1999 and have been in my own practice in Colorado for 
one year and three months. I am loaded with passion, desire and the love of Chiropractic. 
I  am detecting and correcting subluxations, I am a qualified herbologist and 
nutritionialist, and I am currently enrolled to be CCST  (Certified Chiropractic Spinal 
Trauma) but more importantly, its much more than all the fancy names and degrees and 
whatever. It¼s about caring ..and helpingä and going the extra mile..and forgetting about 
making money äand remembering with each new patient that comes thru your door 
..that YOU have something to offer besides your knowledgeä..a smile..and sense of 
commitmentä..a sense of pride..a warm heart and  strong ears, and keen, gentle 
eyes..and a TRUE set of „healing hands¾..   I knew this profession would be great, but its 
been unbelievable and keeps getting better.  But talk to the elder Chiro¼s ..our work has 
just begun..they did the tuff stuff (sat in jail, were ridiculed etc..)  We have work to 
do.Educate.. make people understand how their body  works..get them 
„unbrainwashed¾..The damm TV and media. Drug companies have poisoned too many 
brain cells for too long..   
Things are different now „for the times they are a changing¾

It starts in your office..GO THE EXTRA MILE ää..and if you are burned out for 
whatever reason,..call me or visit me..No I might not have all the answers, and I am the 
„new kid on the block¾ but I¼m here to have some damm fun and help sick people get 
well..

Thanks for helping me with this survey. I¼ll be in touch.
Remember don¼t email this backäsend in an envelope to

 Kirk Chirico DC   POBOX 332   Limon, CO 80828
Tel 719 775 0706    fax 719 775 0706