Primary Care Physician Adult Vaccination Needs Assessment Survey

Please assist the Illinois Academy of Family Physicians understand your adult vaccination perceptions and practice's.  

This short survey has 11 questions and should take about 2 minutes to complete. 

Enter to win a $200 Amazon gift card, courtesy of the IAFP for your time. 

Thank you for your participation! 

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* 1. Years of clinical practice since medical school:

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* 2. Type of Medical Practice

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* 3. Illinois Department of Public Health (IDPH) Regional Office that is closest to your practice?

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* 4. How favorably do you perceive your patients regard vaccination?

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* 5. To your best estimate, what percentage of your adult patients are fully vaccinated?

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* 6. How often do you assess patient vaccination status (using either the medical record or patient questionnaire)? Check all that apply.

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* 7. How do you feel adult vaccination rates in your office have changed since the start of the COVID-19 pandemic?

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* 8. Which of the following do you perceive as obstacles to adult patient vaccinations in your clinic? Check all that apply.

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* 9. Which of the following resources do you use to educate patients about vaccinations? Check all that apply.

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* 10. To what degree do you agree or disagree with the following statements?

  Strongly Agree  Agree Neither Agree nor Disagree Disagree Strongly Disagree
I discuss recommended vaccinations with all of my adult patients.
I feel comfortable recommending vaccines to special patient populations (immunocompromised, HIV, liver disease, etc.).
I have a ready stock of all of the vaccines my patients need.
I routinely have to refer patients to other facilities (eg. department of public health) to receive needed vaccinations.
I don’t have enough time in clinic to educate patients about why they need specific vaccinations.

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* 11. Comments or concerns you have on Adult Immunizations 

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* 12. What education for physicians would you like to see on adult immunizations and vaccines?

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* 13. Enter the drawing for a $200 Amazon Gift Card!  

We will draw one lucky winner and will notify you by email the week of June 19th.

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