#NoBodyIsDisposable Community Survey

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Are you disabled, fat, BIPOC, and/or older? Are you quarantining or delaying medical care because you don’t yet have access to a COVID-19 vaccine? If so, please take this short survey by #NoBodyIsDisposable to help us advocate for our community and increase public awareness of our stories. We won't share any information without your permission.

Note: Some of these questions may be upsetting. Please take care of yourself.

Do you currently identify as any of the following? Please check all that apply

Disabled

BIPOC (Black/Indigenous/Person of Color)

Fat/Higher Weight

Older

Please share more about how you identify, if you are comfortable doing so.

If you are fat/higher weight, please share your clothing size or weight

Do you want to take the COVID-19 vaccine?

Yes

Maybe/Not Sure

Clear selection

Are you currently delaying medical care, treatment, or testing due to COVID-19?

Yes

Clear selection

If yes, how long have you been delaying?

Has delaying care for your condition resulted in potentially permanently life-altering or life-threatening consequences?

Yes

Maybe/Not sure

Clear selection

Please share your story if you would like to. (What have you delayed? How has this impacted your life? Why are you delaying care, treatment, tests...?) We will not share it without your permission.

I give my permission for my story to be used anonymously for advocacy and media. (Note that some advocacy is public, so media could access your story that way, even if you choose "For advocacy only.")

For both advocacy and media

For advocacy only

For media only

Please do not use my story at all

Clear selection

Are you willing to speak directly to reporters about your story? If so please share your name and email address or cell phone number here.

Where are you located? Please include city and state

Would you like to stay in touch to hear about the results of this survey and what's happening next? If yes, please provide your email here.

Is there anything else you want us to know?

Submit

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