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Surveys
2016
May
V
Vaccine Survey for Parents
Vaccine Survey for Parents
Vaccine Survey for Parents
0%
Exit Survey
How did you hear about the elimination of Vaccine exemptions?
New Media (TV, Internet, Radio, etc.)
Social Media
Flyer or Pamphlet from your child's school
From your child
From other parent
Other
Do you agree with mandatory vaccine for children (except for medical reasons i.e. allergic)?
Strongly Disagree
Somewhat Disagree
Neither Agree nor Disagree
Somewhat Agree
Quarterly Strongy Agree
Feelings
Was your child or children current with all CDC recommended vaccines prior to the new regulations?
All Children
Some of my Children
None of my children
Unsure or Don't Know
Other
Do you plan on homeschooling your children in the future as a result of the new regulations?
Yes
No
Unsure
Do you feel that vaccines are safe for children?
Definitely Not Safe
Somewhat Not Safe
Unsure
Somewhat Safe
Very Safe
Vaccines Safe?
Do you feel the community safer from disease outbreaks with the new regulations?
More Safe
No Change
Don't know/Not Sure
Did your child get vaccinated at their school? If so, please provide feedback on the experience.
No
Yes, Provide Feedback:
Do you have any concerns regarding these new regulations?
No
Yes
What is your gender?
Male
Female
Prefer not to answer
What is your age?
Younger than 18
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 or older
Prefer not to answer
What best describes your employment status?
Employed full-time
Employed part-time
Self-employed
Unemployed, looking for work
Unemployed, not looking for work
Student
Retired
Homemaker
Military
Prefer not to answer
Other
Which of the following categories best describes your annual income?
Under $15,000
$15,000 - $29,999
$30,000 - $44,999
$45,000 - $59,999
$60,000 - $74,999
$75,000 - $89,999
$90,000 or more
Prefer not to answer
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