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COVID-19 Vaccination Clinic Survey
We want to hear your feedback so we can keep improving our logistics for our clinics. Please fill out this quick survey and let us know your thoughts. Your answers will be anonymous.
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瞭解詳情
* 表示必填問題
What date was your Covid-19 Vaccine appointment?
MM
/
DD
/
YYYY
Which location did you receive your Covid-19 vaccine?
*
Ottawa County JFS Building
Oak Harbor High School
Camp Perry CMP Air Rifle Range
Ottawa County Health Department
Magruder Hospital
其他：
Was this a first dose or second dose clinic?
*
First Dose
Second Dose
Please enter your age.
您的回答
Was the location easily accessible?
Yes
No
清除選取的項目
Was there enough parking available?
Yes
No
清除選取的項目
How would you rate the following clinic stations?
1 - Not Satisfied 5 - Very Satisfied
1
2
3
4
5
N/A
Scheduling appointment
Parking lot flow
Registration on site
Vaccine station
Second dose scheduling
Observation
1
2
3
4
5
N/A
Scheduling appointment
Parking lot flow
Registration on site
Vaccine station
Second dose scheduling
Observation
清除選取的項目
How would you rate the interaction with the staff and volunteers?
Not Satisfied
1
2
3
4
5
Very Satisfied
清除選取的項目
How would you rate your overall experience?
Not Satisfied
1
2
3
4
5
Very Satisfied
清除選取的項目
Please enter any additional comments or feedback
您的回答
Please enter your name (Optional)
您的回答
提交
清除表單
請勿利用 Google 表單送出密碼。
這份表單是在 Ottawa County, Ohio 中建立。
檢舉濫用情形
表單
