COVID Vaccine Interest Survey

The COVID-19 pandemic has impacted all of our lives in different ways. More than 33.5 million people across our nation have been infected and here in Virginia, 11,360 people have lost their lives. The Portsmouth Health Department needs your help to better understand our community and your needs in regards to COVID-19 Vaccination. Please take a few minutes to answer the following questions to help us in our vaccination approach.

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* 1. Gender

Male

Female

Other

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* 2. Age

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* 3. Race

African American/Black

Caucasian/White

Native American/Alaska Native

Asian American/Pacific Islander

Multi-racial

Other

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* 4. Ethnicity

Hispanic/Latino

Not Hisapnic/Latino

COVID Vaccine Interest Survey

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* 1. Gender

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* 2. Age

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* 3. Race

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* 4. Ethnicity

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* 5. Occupation

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* 6. Zip Code (where you live)