COVID-19 Vaccination Clinic Survey
We want to hear your feedback so we can keep improving our logistics for our clinics. Please fill out this quick survey and let us know your thoughts. Your answers will be anonymous.
What date was your Covid-19 Vaccine appointment?
MM
/
DD
/
YYYY
Which location did you receive your Covid-19 vaccine? *
Was this a first dose or second dose clinic? *
Please enter your age.
Was the location easily accessible?
Clear selection
Was there enough parking available?
Clear selection
How would you rate the following clinic stations?
1 - Not Satisfied 5 - Very Satisfied
1
2
3
4
5
N/A
Scheduling appointment
Parking lot flow
Registration on site
Vaccine station
Second dose scheduling
Observation
Clear selection
How would you rate the interaction with the staff and volunteers?
Not Satisfied
Very Satisfied
Clear selection
How would you rate your overall experience?
Not Satisfied
Very Satisfied
Clear selection
Please enter any additional comments or feedback
Please enter your name (Optional)
Submit
Never submit passwords through Google Forms.
This form was created inside of Ottawa County, Ohio. Report Abuse