Our Gila County COVID-19 Response team is conducting a survey of our communities perspective towards the COVID-19 vaccination. This will assist our team in planning for the distribution of the COVID-19 vaccine when it becomes available in Gila County content for the survey. 

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* 1. What zipcode do you reside in?

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* 2. Have you or someone you know been infected with COVID-19?

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* 3. Do you have children?

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* 4. When a COVID-19 vaccine becomes available, how likely would you or your child(ren) get vaccinated?

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* 5. If you answered I will probably NOT get it or I will definitely NOT get it, what best describes the reason why?

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* 6. Please indicate how much the following scenarios would influence your decision, if at all, to get the COVID-19 vaccine:

  VERY UNIKELY to get the vaccine SOMEWHAT UNLIKELY to get the vaccine UNLIKELY to get the vaccine NO DIFFERENCE in my decision Not sure
If the vaccine requires two doses
If you have to get the vaccine every year
If you have to pay out of pocket

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* 7. If you decide to receive the vaccine, where would you be comfortable receiving the COVID-19 vaccine if you choose to do so?

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* 8. What age groups are you and your child(ren)in?

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* 9. Do you anyone in your household belong to any of the following priority groups? Please check all that apply.

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