COVID Vaccination Survey
Post Graduate Government College,Sector-46, Chandigarh
Your e-mail address *
Full Name *
Class *
College Roll No. *
Mobile Number *
Gender *
Date of Birth *
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Have you ever tested positive for SARS-CoV-2 in the past? *
If yes,mention the date and month.
MM
/
DD
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YYYY
Have you got vaccinated  ? *
On which date was the first dose administered?
MM
/
DD
/
YYYY
Vaccine administered
Clear selection
On which date is the second dose of vaccine due?
MM
/
DD
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YYYY
If not vaccinated, mention the reason *
Submit
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