Needle Shortage Survey
Please fill out the short survey below and tell us if your site has been experiencing needle shortages. The Philadelphia Immunization Program is working to better understand the need throughout the city and identify ways to address it.

If you have any questions, please contact vaccines@phila.gov.
1. VFC/VFAAR Pin #
2. Site name
3. Site address
4. Contact Name *
5. Contact Title *
6. Contact Email address *
7. Contact Phone #
8. Which needles are you currently having trouble accessing (Select all that apply): *
Required
9. How long do you estimate your current supply of needles will last? *
10. How many needles do you typically use in a week? *
11. Select the statement that best matches the current situation at your site: *
12. Are there additional details about the challenges that your practice is having accessing these supplies that we should be aware of?
Submit
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