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COVID Vaccine survey

Thank you in advance for taking the time to do this survey. Please help us understand your views on COVID-19 vaccinations by answering the below questions. We want to make sure every member of our community voice is heard. Your responses will be anonymous.

1. Have you taken any vaccines? *

2. If you have been vaccinated, how many doses have you taken?

1st dose only
1st and 2nd dose
1st, 2nd and booster

3. If you had the vaccine, could you please tell us the reason why?

4. Right now, how likely are you to have a COVID vaccine? Should not be required if answered Yes to Question 1.

Definitely not	Unlikely	Slightly likely	Probably	Definitely
Definitely notBlack Grey Pattern Shoes Definitely not	UnlikelyBlack Grey Pattern Shoes Unlikely	Slightly likelyBlack Grey Pattern Shoes Slightly likely	ProbablyBlack Grey Pattern Shoes Probably	DefinitelyBlack Grey Pattern Shoes Definitely

5. What are the reasons why you might not have a COVID vaccine? (tick all that apply) should be required if you answered No to question 1.

Safety Concern i.e. lack of testing, rapid development, etc
Longevity
Side Effect i.e. Fertility, Blood cloths, etc
Fear of needles
Against belief i.e. Religion, Personal, etc

6. Where have you been able to get information about COVID vaccines? *

Name (optional)

First

Last

All personal data will be held in compliance to our data policies and GDPR. We will NOT share any personal information with any of our partners.

COVID Vaccine survey

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