Covid-19 Community Response
We want to hear from our communities that have experienced the effects of COVID-19.
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Email *
Have you ever been diagnosed with COVID-19? *
If yes. can you please share your experience?
Did you have any family members or friends that where diagnosed with COVID-19? *
Have you lost family members or friends to COVID-19 *
Have you received at least one dose of the COVID-19 vaccination shot? *
How much do any of the following factors impact your decision to be vaccinated?
Adequate information on how the vaccine was made: *
Knowing someone who is fully vaccinated: *
Being mandated by my employer: *
Knowing that my healthcare provider is fully vaccinated: *
During the height of the pandemic in 2020, did you have COVID-19 symptoms but were denied a COVID-19 test? *
Is there anything else you would like to share regarding your opinions on the COVID-19 vaccination. *
Race/Ethnicity *
Gender *
Age Range *
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