TXHC-Flu Prevention Survey 2020 Question Title * 1. Please check where you live: Bloomington (Zip code: 77951) Inez (Zip code: 77968) McFadden (Zip code: 77973) Nursery (Zip code: 77976 Placedo (Zip code: 77977 Telferner (Zip code: 77988) Victoria (Zip code: 77901) Victoria (Zip code: 77902) Victoria (Zip code: 77904) Victoria (Zip code: 77905) Question Title * 2. How many people are in your household? 1-2 3-4 5+ Question Title * 3. How many children (if any) are in:*Enter a number in the field (use 0 if none) Pre-K (0-4) Elementary School (K-5th) Middle School (6th-8th) High School (9th-12th) None Question Title * 4. What is your annual household income? Less than $10,000 $10,000-$19,999 $20,000-$29,999 $30,000-$39,999 $40,000-$49,999 $50,000-$59,999 Over $60,000 Question Title * 5. Do you get a flu shot yearly? Yes No Sometimes Question Title * 6. If you answered no to question #5, why? Feel not needed Flu shot (vaccine) is not safe Do not know where to go to get flu shot Cannot afford flu shot Other (please specify) Question Title * 7. Do your children get a flu shot yearly? Yes No Sometimes Question Title * 8. If answered no to question #7, why? Feel not needed Flu shot (vaccine) is not safe Do not know where to go to get flu shot Cannot afford flu shot Other (please specify) Question Title * 9. Do you know the signs of flu? Yes No Not sure Question Title * 10. Which of the following are signs of flu? (check all that apply) Fever Cough Stomach ache Sore throat Muscle or body aches Foot pain Runny or stuffy nose Vomiting Diarrhea Question Title * 11. Do you know the benefit of the flu shot (vaccine)? Yes No Not sure Question Title * 12. Which of the following are the benefits of the flu shot (vaccine)? (check all that apply) Prevents common colds Prevents illnesses and flu-related doctor's visits Lowers the risk of hospitalizations or complications in older adults and children Lowers the risk of hospitalizations or complications in people with chronic conditions Reduces back pain Reduces the risk of more serious flu outcomes Done
