Glendale Riverhills - Health Services Survey
1.
Would you or anyone in your family be interested in receiving a COVID-19 vaccine at your child's school?
Yes
No
2.
If yes, how many peopole in your household need their primary series of the COVID-19 vaccine? Please also indicate the age of each participant.
3.
If yes, how many people in your household need a COVID-19 booster dose? Please also indicate the age of each participant.
4.
Would you or anyone in your household be interested in receiving a flu vaccine at your child's school?
Yes
No
If yes; How many people and what are their ages
5.
Would you are anyone in your family be interested in getting a Tdap vaccine at your child's school?
Yes
No
If Yes: How many people would be vaccinated and please provide their ages.
6.
What type of insurance do you have?
Private
State funded
No insurance
7.
Would you or anyone in your household be interested in getting lead tested at your child's school?
Yes
No
8.
If you answered 'yes' to any of the above services, please provide your email address to recieve further information about our upcoming clinic.