Multicultural Women Victoria (formerly VIRWC), with this survey, aims to understand COVID-19 vaccination rates,  associated issues and where support is required
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Your Full Name *
Your Age *
Have you been vaccinated? *
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If you have not been vaccinated, could you kindly select reasons/concerns
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Other Reason Not Vaccinated
If you need any support (more information, help getting to a vaccination hub, etc.), please leave us your mobile number and/or email below
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This form was created inside of VIRWC - Victorian Immigrant Refugee Women Coalition. Report Abuse