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Exit Survey
 
 
How likely are you to get vaccinated?
 
Very likely 
 
Likely 
 
Less likely 
 
Never
 
 
 
I receive annual vaccinations
 
Always 
 
Never 
 
Only when required
 
 
 
Select your biggest concern with vaccinations.
 
cost
 
side effects
 
No urgency
 
Risks greater than benefits
 
 
 
Select the health concern that has prevented you from receiving vaccinations.
 
Diabetes
 
Weakened Immune System
 
Allergies
 
None
 
 
 
Select the health concern that has encouraged you to be vaccinated.
 
Diabetes
 
Weakened Immune System
 
Allergies
 
None
 
 
 
Select the vaccination that you are more hesitant to receive.
 
Flu
 
Pneumonia
 
HPV
 
MMR
 
None
 
 
 
Select the vaccination you are more likely to receive.
 
Flu
 
Pneumonia
 
HPV
 
MMR
 
None
 
 
 
I received a vaccination and then contracted the disease it was supposed to protect me from.
 
Yes
 
No
 
 
 
Vaccinations should be mandated for health professions and school age children.
 
Strongly Disagree
 
Disagree
 
Neither Agree or Disagree
 
Agree
 
Strongly Agree
 
 
 
Vaccinations should only be mandated for clinical professions.
 
Strongly Agree
 
Agree
 
Neither Disagree or Agree
 
Disagree
 
Strongly Disagree
 
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