Onsite Vaccination Survey
Thank you for taking the time to complete this short survey. The Winnebago County Health Department has capacity to bring COVID-19 vaccine clinics directly to interested businesses and organizations. With your answers, we hope to better serve your business and our community.
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Business/Organization Name: *
Contact Name: *
Contact Title:
Contact Phone Number: *
Contact Email: *
Is your business or organization currently connected with a health care system that provides onsite services?
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How many employees do you anticipate participating in a vaccine clinic at your location? *
We expect onsite vaccination clinics to last about 2 hours. Please check all available times below that would work for your organization. *
Required
Can we provide any additional information for you about the COVID-19 vaccines or other local vaccination clinics? *
Thank you for taking the time to complete this quick survey. Please provide any additional feedback here.
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