Survey 2022
Who we are:

The Health Independence Alliance is an independent medical body with no political, governmental, or financial affiliations and consists of medical professionals from Utah, including a Cardiologist, Virologist, Registered Nurses, Fertility Nurses and Homeopaths. Our goal is to help provide accurate information to Utahns regarding health topics.

The purpose of this survey is to enable Utahns to connect to help that they might need. This information will be kept confidential, and will only be released to the relevant professionals if voluntarily requested in this survey. It will not be used for marketing or commercial purposes.

For any further questions, please contact us at healthindependencealliance@gmail.com or call us at (801) 252-6021.
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Email *
Name *
Age *
City *
Your latest vaccine shot *
Vaccine Type *
Side Effects Experienced *
Are you interested in seeking legal remedies? *
Are you interested in connecting with a health care professional for treating your side effects? *
Did you take the vaccine only due to employment or school related requirements? *
How did you hear about us? *
A copy of your responses will be emailed to the address you provided.
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