What are your questions about COVID-19?
Atlantic City residents: Let us know if you have any questions about COVID-19, and how we can help you get the information you need to keep your family protected. This is an anonymous survey that will keep your answers private.
Sign in to Google to save your progress. Learn more
What do you want to know about COVID-19 or the COVID-19 vaccine?
How can we help you and your family stay protected? Choose as many as you like.
Where would you like to get information about COVID-19? Choose as many as you like.
If you would like COVID-19 information in a language other than English, please tell us that language below.
If you would like us to send you information about COVID-19 and COVID-19 vaccination, please type your email address below.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms