Hello! This Google form is intended to gain information about the vaccine and its impact within San Bruno. It will only take a minute to complete this survey. The information used within this survey is confidential and will only be utilized for research purposes only. Thank you very much for taking the time out of your day. It is greatly appreciated.
Your email and personal information will not be recorded when you submit this form.
What is your race?
Black/ African American
Hawaiian Native/ Other Pacific Islander
Have you gotten COVID-19 before?
If you answered yes to the question above, have you been required to quarantine for the allocated 14 days?
Have you fully received the COVID-19 vaccine
Yes, but only the first dose
If you answered yes to the question above, which vaccine did you receive?
Johnson & Johnson
If you have received the vaccine, why did you get it (ie."I got the vaccine because I wanted to protect my family")
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