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Immunize Colorado Focus Group Interest Form

Please fill out this form by Friday, July 3rd to express your interest in participating in a virtual focus group to review Immunize Colorado's survey on the implementation of Senate Bill 25-194. Focus group dates/times will be finalized based on the responses we get. Participants will receive a $25 gift card as compensation for their time. Please direct any questions to Bennett.Nye@childrenscolorado.org or Sarah.Waraniak@childrenscolorado.org.
1.What is your name?(Required.)
2.What is your role/job title?(Required.)
3.What is the name of your practice and where is it located?(Required.)
4.What dates/times would work best for you to attend a focus group? (Please select all that apply)(Required.)
5.Other comments