COVID-19 Vaccine and the GPW Community

We are asking community members to take a few moments to answer questions about their thoughts on the COVID-19 vaccine. This will help the Prince William Health District and partners to understand the community's acceptance of the COVID-19 vaccine and where they find their information. Please take a few moments to let your voice be heard! 

For more information about the COVID-19 vaccine and Virginia's vaccination response, please visit: vdh.virginia.gov/covid-19-vaccine
1.Will you accept a COVID-19 vaccine when it is available?(Required.)
2.Will you accept a COVID-19 vaccine if your employer recommends it? (Required.)
3.Will you accept a COVID-19 vaccine if your healthcare provider recommends it?(Required.)
4.What are your concerns with receiving a COVID-19 vaccine? (please check all that apply)(Required.)
5.Where do you get your information currently about the COVID-19 vaccine? (please check all that apply)(Required.)
6.Are you or have you been diagnosed with COVID-19?(Required.)
7.Do you know anyone who is or has been diagnosed with COVID-19?(Required.)
8.Did you get a flu shot this year? (Required.)
9.What is your home zip code? (Required.)
10.What gender do you identify with? (Required.)
11.What is your age?(Required.)
12.What is your race?(Required.)
13.Are you Hispanic/Latino?(Required.)
14.What is your education level? (Required.)
15.What is your annual household income? (Required.)
16.What is your occupation? (please check all that apply)(Required.)
17.Please take the opportunity to share anything else with us. We value your feedback. (Required.)