How Do You Feel About the Covid-19 Vaccine?

We value your thoughts about the COVID-19 vaccine and would appreciate it if you could submit your feedback via this poll.

The information collected from this poll will assist The City of Wauwatosa Health Department as we tailor our vaccine response to community needs.

**All personal information will remain anonymous and no personal or identifying information from this survey will be shared**

The first four questions are optional but will help us better understand our different communities. Please provide an answer or select the options that best describe you.

Thank you so much for your feedback, The City of Wauwatosa Health Department greatly appreciates your input! If you have any questions or concerns please contact at mspredemann@wauwatosa.net or by phone 414-479-8936

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* 1. How old are you?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 2. How do you currently describe yourself?

Male

Female

I prefer not to answer

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* 3. What is your ethnicity?

Hispanic of Latino

Not Hispanic or Latino

I prefer not to answer

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* 4. What is your race?

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Something else

I prefer not to answer

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* 5. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 6. Which statement best describes how to feel about the COVID-19 Vaccine?

I already have gotten my COVID-19 Vaccine

I will probably get it

I am undecided

I will probably not get it

I will definitely not get it