Key Biscayne COVID-19 Vaccination Survey

A survey by the Key Biscayne Community Foundation in partnership with the Village of Key Biscayne and the Key Biscayne Chamber of Commerce. We are collecting data in order for local officials to make informed decisions related to vaccinations.

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* 1. Are you 65 years or older?

Yes

No

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* 2. Are you already vaccinated against Covid-19?

Yes

No

I have an appointment.

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* 3. If you have not received a vaccine, would you like to be vaccinated against Covid-19?

Yes

No

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* 4. If you do not want to be vaccinated, please tell us why (you do not have to answer to continue)?

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* 5. If you would you like to be vaccinated, would you like assistance in scheduling an appointment?

Yes

No

Not yet

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* 6. If you received a vaccination appointment off-island, would you need transportation?

Yes, I would need transportation.

No, I do not need transportation.

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* 7. Please enter your contact information in order to be contacted if appointments become available. You do not have to enter to submit, only complete if you want to be contacted regarding an appointment for a vaccination.

Full Name

Email Address

Phone Number