Glendale Riverhills - Health Services Survey

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1.Would you or anyone in your family be interested in receiving a COVID-19 vaccine at your child's school?

Yes

No

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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.

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3.If yes, how many people in your household need a COVID-19 booster dose? Please also indicate the age of each participant.

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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

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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.

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6.What type of insurance do you have?

Private

State funded

No insurance

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7.Would you or anyone in your household be interested in getting lead tested at your child's school?

Yes

No

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8.If you answered 'yes' to any of the above services, please provide your email address to recieve further information about our upcoming clinic.