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COVID Now
Since the COVID-19 Public Health Emergency has ended, we would like to learn how COVID affects you and your community now.
1.
What is your ZIP Code?
2.
How concerned are you about getting COVID-19?
Not at all concerned
A little concerned
Somewhat concerned
Very concerned
3.
How important do you think getting a COVID-19 vaccine is to protect someone from serious illness and/or complications due to COVID-19?
Not at all important
A little important
Somewhat important
Very important
4.
How safe do you think a COVID-19 vaccine is for you?
Not at all safe
A little safe
Somewhat safe
Very safe
5.
To your knowledge, have you ever had COVID-19?
Yes
No
6.
How much do you trust your healthcare provider to give you accurate and useful information about vaccines?
Do not trust
Somewhat trust
Mostly trust
Fully trust
I don’t have a regular healthcare provider
7.
How much do you trust the public health agencies that recommend COVID-19 vaccines?
Do not trust
Somewhat trust
Mostly trust
Fully trust
8.
Has your doctor, nurse, or other health professional ever recommended that you get a COVID-19 vaccine?
Yes
No
I don’t have a regular healthcare provider
9.
Have any of the following influenced your decision to get a COVID-19 vaccine and/or booster shot? (Select the ones who have influenced you the most.)
Family
Friends
Co-Worker
Schools
Religious Leaders
Doctor or Healthcare Provider
Government Officials
Media/advertisements/celebrities
None
10.
In the last month, have you seen or heard any negative information about the safety or effectiveness of COVID-19 vaccines?
Yes
No
11.
In the last month, have you seen or heard any positive information about the safety or effectiveness of COVID-19 vaccines?
Yes
No
12.
How much do you agree with the following statement?
I have a responsibility to get vaccinated for COVID-19 to protect others.
Do not agree
Somewhat agree
Strongly agree
Very strongly agree
13.
How difficult is it to get a COVID-19 vaccine in your community now?
Not at all difficult
Somewhat difficult
Very difficult
Don't know
14.
Which of the things in this list do you think may make it difficult to get a vaccine in your community now? (select all that apply)
Getting an appointment online
Not knowing where to get vaccinated
Hard to get to vaccination sites
Vaccination sites aren't open at convenient times
Cost of the vaccine
Don't know
None
Other (please specify)
15.
Have you received at least one dose of a COVID-19 vaccine?
Yes
No