Covid19

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* 1. How do you feel about getting the COVID-19 vaccine?

I will get the vaccine.

I will probably get the vaccine.

I am undecided about taking the vaccine.

I will not get the vaccine.

I have already got the vaccine.

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* 2. If your answer is other than “I will get the vaccine or I have already got the vaccine, “what is your reason for not wanting to take it?

I am concerned about side effects and safety.

I am concerned that it will make me sick.

I do not think that I need it.

I think that it will cost too much.

I do not have insurance

I do not have time to get two vaccines.

I never take vaccines.

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* 3. Have you or someone you know gotten COVID -19?

Yes

No

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* 4. Are you concerned about the COVID-19 pandemic?

Yes

No

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* 5. Do you usually wear a mask or face covering when in public?

Always

Sometimes

Never

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* 6. Do you stay at home when you are feeling sick?

Always

Sometimes

Never

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* 7. What is your age group?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 8. What is your zip code?

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* 9. If you would like to get a vaccine, have you been able to get one?

Yes

No