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Disability Rights New Mexico COVID-19 Vaccination Access Survey
1.
What is your race or ethnicity?
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Multiracial or Multiethnic
Native American or Alaska Native
Native Hawaiian or other Pacific Islander
White
Another race or ethnicity, please describe below
Self-describe below:
2.
What is your age?
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older
3.
Are you a person living with a disability?
Yes
No
4.
Type of disability.
Hard of Hearing or Deaf
Learning Disability
Blind/ Visual Impairment
Physical/Orthopedic Impairment
Traumatic Brain Injuries (TBI)
Neurological Disorders
Other (please specify)
5.
Have you been able to access the COIVD-19 vaccine?
Yes
No
Other (please specify)
6.
What issues have you faced accessing the COVID-19 vaccine?
Current Progress,
0 of 6 answered
