Injections and Shots Surveys

Question Title

* 1. Do you have to take a regular injection or shot?

Yes

No

Other (please specify)

Question Title

* 2. If you do take a regular shot or injection, what is the frequency?

Weekly

Monthly

Every Two Months

Not Applicable

Other (please specify)

Question Title

* 3. Shots or Injections provided by a health care professional regularly in Gold Bridge would be helpful to you or a family member?

Yes

No

Comment

Question Title

* 4. A little demographic information.....

Full Time Resident

Part Time Resident (weekends, holidays, periods of time)

Here for work seasonally

Other (please specify)

Question Title

* 5. Is there anything else you would like to say?