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* 1. If offered, how likely are you to get the covid vaccine? On a scale of 1-5

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* 2. If yes, which reasons would you say influenced your decision? (select all that apply)

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* 3. Do you have concerns about the safety of the vaccine?

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* 4. If yes, can you describe your concern? (open ended Q)

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* 5. Will this affect whether or not you choose to get the vaccine?

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* 6. Do you have concerns about possible side effects of the vaccine?

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* 7. Will this affect whether or not you get the vaccine?

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* 8. If you are going to decline the vaccine, is there another reason? Please describe. (open ended)

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* 9. Which sources do you see as most reliable for your covid information? (select all that apply)

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* 10. Do you have any questions that you’d like answered by a community health nurse? (open ended)

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