California COVID-19 vaccine survey

Thank you for taking time to provide feedback.

We estimate this will take 5 to 10 minutes of your time.

It is more important than ever that our state government hear from Californians. This survey is an effort to give Californians the opportunity to share their experiences related to COVID-19 vaccines and their impact.

Please be advised this survey is for informational purposes only. If you are experiencing an emergency, please dial 911 or your local authorities.

Question Title

* 1. Do you get a flu shot or other vaccines (e.g., chicken pox, measles, mumps, rubella)?

Yes

Not sure

Question Title

* 2. Have your children ever taken a vaccine such as chicken pox, measles, mumps or rubella?

Yes

Not sure

I do not have children

Question Title

* 3. How satisfied are you with the state of California's vaccination program?

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

Question Title

* 4. Do you plan to get a COVID-19 vaccine?

I have taken or started taking a COVID-19 vaccine

Yes

Not sure