COVID-19 Vaccine Survey Form

Were you infected by COVID-19?

Yes No

Do you have any family members or loved ones who got infected with COVID-19?

Yes No

Have you been fully vaccinated?

Yes No

If you haven't gotten any vaccines, are you willing to be vaccinated if the vaccine is offered to you?

Yes Maybe No

If you had been fully vaccinated, are you willing to get a booster shot?

Yes Maybe No

Do you think children should be vaccinated against COVID-19?

Yes Maybe No

Which vaccine do you prefer?

Pfizer/BioNTech Moderna Johnson & Johnson/Janssen Astrazeneca Sputnik Coronavac/Sinovac Sinopharm Covaxin/Bharat Biotech Not in the list: I'm ok with any brand of vaccines I won't take any vaccines