Monday, December 24, 2012

Circumcision Refusal Form

This form is provided here as an example on how to be concise, yet specific, and firm yet not hostile. This form is not intended to replace legal advice and you should always consult your own legal assistant if you have questions or concerns.

 Circumcision Refusal Form 

Attention: Staff, Physicians, Nurses and other personnel at:

Facility Name:__________________________________________________________ Address:_______________________________________________________

This is a formal refusal to consent to routine infant circumcision. You are hereby notified that our child, _____, is NOT to be circumcised.

This also serves as a formal refusal to consent to retraction, stretching or any other manipulation of the prepuce (foreskin on males and clitoral hood on females) of our child, ____.

Solicitation or discussion of routine circumcision and prepuce retraction is unnecessary, as we the parents have refused to consent to these procedures.


Mother: _________
Father: __________


Note that the magic words in the medical setting are: I refuse to consent. We refuse consent. I do not consent. Those are the words that work for the lawyers and the ones they are trained to hear.

Anything that is open to interpretation or that turns your stance into an opinion should be avoided. Avoid words such as: Prefer, wish, desire, want, like, hoping, counting on, interested in, etc.

If your consent will change based on circumstances, then specifically mention those circumstances. Avoid phrases such as, "Unless medically necessary" or "Except in emergencies" because those are open to interpretation and represent your automatic approval instead of requiring them to come to you in that moment.

Additionally, if you remain concerned about the behavior of the staff or you are receiving harassment, consider placing a card in the baby's isolette with a summary of the above.

"Hi, my name is _______. My parents refuse to consent to circumcision and retraction for me. If you have questions, refer them to my mother in room: _____ and father at: ________." 

 You can also consider screenprinting a basic baby onesie with something loud and simple such as, "DO NOT CIRCUMCISE" and "DO NOT RETRACT."
Some might even find this necessary, although
this is more wisely saved for hostile situations.

Related posts:
If your son was mistreated (retracted, circumcised) please read this post:

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