Rabies is a viral disease that is nearly 100% fatal to humans once symptoms appear.

By signing below, I, the individual potentially exposed (or the legal guardian of the minor exposed), formally confirm and agree to the following:

I was informed by the Essex County Health Department of a risk of rabies exposure based on New York State’s Exposure Criteria and Guidance.
I was advised that rabies is a fatal disease if left untreated.
I was advised of the recommendation to receive the full RPEP treatment.
I had the opportunity to discuss this exposure risk and the recommended RPEP with my Health Care Provider (HCP).
After careful consideration, I have decided to decline the Rabies Post-Exposure Prophylaxis (RPEP) for myself (or my child, if signing as a guardian).

By signing I understand and accept the potential, life-threatening consequences of declining rabies treatment.

Rabies Declination Form