Naugatuck Valley Health District Community Survey

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1. Please check your age range:

2. Please check the city/town where you live:

3. In general, what shots are recommended for adults? Check all that apply:

4. Please answer the following questions related to doctor recommendations

5. If you did not recieve the shot your doctor recommended, why didn't you? Check all that apply:

6. Where can you go to get a shot if needed? Check all that apply:

7. How do you pay when you get a shot? Check all that apply:

8. Where do you get your health information from? Check all that apply:

9. What time of day is most convenient for you to get a shot?