Survey: Vaccination Status

A diverse group of people happily receiving vaccines at a community health center, with an emphasis on safety, care, and support.

Vaccination Status Survey

Participate in our quick survey to share your vaccination status and help us understand the community's health needs. Your feedback is invaluable in ensuring everyone is well-informed and supported in their vaccination journey.

By completing this survey, you can:

Provide important data on vaccination rates.
Help identify those who may need assistance with scheduling vaccinations.
Contribute to a healthier community.

4 Questions1 MinutesCreated by EngagingHealth101

Name: (Last Name, First Name)

What is your vaccination status as of today?

Fully Vaccinated (Completed 1st and 2nd dose)

Partially Vaccinated (Completed 1st dose only)

Not yet vaccinated (Has vaccination schedule already)

Not yet vaccinated (No vaccination schedule yet)

Will not get vaccination

For those who are vaccinated already: Do you have a vaccination card?

Yes, I have a vaccination card

No, I don't have a vaccination card yet

For those who are not vaccinated yet and has no vaccination schedule yet, Would you like the school to help for a vaccination schedule?

Yes, I would like to ask for help for a vaccination schedule

No, we will look for our own vaccination schedule

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