How Do You Feel About the COVID-19 Vaccine?

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* 1. What county do you live in?

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* 2. What is your gender?

Male

Female

Other (please specify)

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* 3. What is your age group?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 4. What is your race?

White or Caucasian

Black or African American

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Other (please specify)

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* 5. What is your ethnicity?

Hispanic

Non-Hispanic

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* 6. Are you planning on getting vaccinated for COVID-19?

I'm already vaccinated.

Yes, I am planning on being vaccinated.

No, I am not getting vaccinated.

I am undecided.

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* 7. If you answered No or Undecided, why not?

Concerned about vaccine approval process

Concerned about vaccine safety and/or side effects

Concerned about fertility, pregnancy, and/or breastfeeding

Vaccine is not effective

Vaccine is unnecessary

Not concerned about contracting COVID-19

Vaccine is not easily available to me

N/A

Other (please specify)

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* 8. If you have been vaccinated or are planning on getting vaccinated, what led you to that decision?

To protect myself

To protect others

Not sure

N/A

Other (please specify)

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* 9. What is your primary source of information for the COVID-19 vaccine?

Internet

Social Media

News

Healthcare Provider

CDC

GA Department of Public Health

Family/Friends

Other (please specify)

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* 10. Who do you trust in your community to give you advice or guidance about COVID-19 vaccination?

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* 11. Are you supportive of vaccines in general?

Yes

Unsure

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* 12. If you have children, will you have them vaccinated for COVID-19?

Yes

Undecided

I don't have children

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* 13. Is there any information you need to know more about which you feel will help you be more confident about getting the vaccine? Getting your children vaccinated?

Development Process

Safety

Side Effects/Adverse Reactions

Effectiveness

Recommendations for those who have already had the virus

None

Other (please specify)

How Do You Feel About the COVID-19 Vaccine?

Question Title

* 1. What county do you live in?

Question Title

* 2. What is your gender?

Question Title

* 3. What is your age group?

Question Title

* 4. What is your race?

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* 5. What is your ethnicity?

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* 6. Are you planning on getting vaccinated for COVID-19?

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* 7. If you answered No or Undecided, why not?

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* 8. If you have been vaccinated or are planning on getting vaccinated, what led you to that decision?

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* 9. What is your primary source of information for the COVID-19 vaccine?

Question Title

* 10. Who do you trust in your community to give you advice or guidance about COVID-19 vaccination?

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* 11. Are you supportive of vaccines in general?

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* 12. If you have children, will you have them vaccinated for COVID-19?

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* 13. Is there any information you need to know more about which you feel will help you be more confident about getting the vaccine? Getting your children vaccinated?

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* 14. Additional Comments: