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.)
5.If you are not fully vaccinated, will you be by October 7th, 2021?
6.Do you need assistance from RiseBoro in getting an appointment to be vaccinated?
Current Progress,
0 of 6 answered