This survey is designed to measure the interest of Pratt County residents in receiving a COVID-19 vaccine. The way the vaccine is distributed to high-risk groups and the general public will depend on many factors. Your answers will help us plan for vaccine distribution.

Thank you for your participation in this short 2 minute survey.

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* 1. Are you interested in receiving a COVID-19 vaccine as soon as it becomes available, even if it requires two doses for full immunization?

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* 2. Do you belong to any of the following priority groups for vaccination? Please check all that apply.

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* 3. Does anyone in your household belong to any of the following priority groups? Please check all that apply.

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* 4. Have you been laboratory confirmed to have COVID-19 within the last 90 days?

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* 5. If you have children 18 years or younger, will you get a COVID-19 vaccine for your children as soon as it becomes available?

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* 6. What is your gender?

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* 7. What is your age?

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* 8. Do you live in Pratt County, Kansas?

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* 9. How do you receive information on the COVID-19 updates and vaccine availability?

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* 10. Please add any questions, comments, or suggestions for vaccination information and distribution of the COVID-19 vaccine in Pratt County. We appreciate your input!

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* 11. If you would like to be contacted once we have vaccine available for you, please fill out your contact information. We will call you to schedule an appointment.

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