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The Pediatric Pulse:
The Impact of Vaccine Delivery
and Payment Coverage on Patient Care

As part of our ongoing commitment to improve immunization access and delivery for patients across NJ, please complete this survey to share your feedback on vaccine accessibility, administration, and payment coverage. The information will help advocate for meaningful change. Thank you!
1.Which of the following best describes you?(Required.)
2.What type of pediatric practice do you work with?
(Check all that apply)(Required.)
3.What is the name and location (zip code) of your practice/organization? (List all that apply)(Required.)
4.Which insurance plans do you currently accept?
(Check all that apply)(Required.)
5.Your office provides vaccines to:
(Check all that apply)(Required.)
6.Which of the following vaccines do you currently offer in-office?
(Check all that apply)(Required.)
7.What barriers does your practice face in stocking and administering vaccines?
(Check all that apply)(Required.)
8.When do you administer vaccines?
(Check all that apply)(Required.)
9.Where do you track immunizations?
(Check all that apply)(Required.)
10.Who is primarily responsible for ordering and managing vaccines?
(Check all that apply)(Required.)
11.Do you have appropriate cold storage units (fridge/freezer) with temperature monitoring (if needed)?(Required.)
12.Have you had to discard vaccines or had issues due to:(Required.)
13.What payment/reimbursement challenges does your office face for vaccines?
(Check all that apply)(Required.)
14.Do financial concerns prevent you from offering certain vaccines?(Required.)
15.How often do you face family/patient vaccine hesitancy?(Required.)
16.Which tools/education materials does your office use?
(Check all that apply)
17.Is there anything else you'd like us to know about vaccine delivery in your pediatric office?
18.Please provide your name and contact information if you're open to follow-up discussions regarding this topic:
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