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HHA Vaccination-english
*
1.
What is your full name?
(Required.)
2.
What is your email address?
3.
What is your phone number?
*
4.
Are you fully vaccinated against the Covid-19 virus?
(Required.)
Yes
No
No, but I am partially vaccinated
5.
If you are not fully vaccinated, will you be by October 7th, 2021?
Yes
No
NA/I am fully vaccinated
6.
Do you need assistance from RiseBoro in getting an appointment to be vaccinated?
Yes
No
Current Progress,
0 of 6 answered
