We are looking for feedback!

This survey is designed to see what the need in Jefferson County is regarding the Covid-19 Vaccine. By taking this survey, you are not signing up to receive a vaccine, but helping us plan and assist the needs of the community. 

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* 1. Are you interested in receiving the Covid-19 Vaccine?

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* 2. What is your age?

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* 3. If given the choice, which vaccine would you want?

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* 4. What is your zip code?

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* 5. If you area interested in receiving emails regard PAH and vaccine information, please enter your email address. 

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* 6. Do you have a friend or loved on that is interested in receiving the vaccine and does not have access to the online survey?

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