COVID-19 Readiness
We are hoping to offer the COVID-19 vaccine soon! As always, we are interested in your thoughts and feelings, by filling out this short survey you will be assisting the clinic in making sure your questions and concerns are addressed so that you feel prepared and informed when it is your turn to get vaccinated.

This survey is completely voluntary. The answers you provide will be kept anonymous and completely confidential. We appreciate you taking the time to help us serve you in the best way possible!
Are you a patient at The Corner Health Center? *
To your knowledge, have you ever been infected with COVID-19? *
Do you plan on getting a COVID-19 vaccine when one becomes available to you? *
Do you believe the COVID-19 vaccine is safe? *
Do you believe the COVID-19 vaccine will help you to return to your normal life? *
How concerned are you about getting infected COVID-19? *
Not at all
Very Concerned
How concerned are you about friends and family getting infected with COVID-19? *
Not at all
Very Concerned
How effective do you think the COVID-19 vaccine is at protecting you from infection? *
Not at all
Very effective
How concerned are you about having a reaction to the COVID-19 vaccine? *
Not at all
Very concerned
What concerns do you have about the COVID-19 vaccine? List your top 3. *
Who do you most trust to give you information about the vaccine? Select all that apply. *
Would you like more information about the COVID-19 vaccine? *
If The Corner Health Center provided you with educational information about the COVID-19 vaccines, how would you prefer to receive it? *
What is your age? *
Race/ethnicity (select all that apply) *
What is your gender? *
What zip code do you live in? *
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