COVID QUESTIONAIRE

Please help us by filling out this information sheet

COVID Questionnaire

Name

First Name

Last Name

Email Address

Message

Please select one

I have been vaccinated for COVID-19

I have NOT been vaccinated for COVID-19

If you have not been vaccinated, please select from below

I plan on being fully vaccinated by August 2

I do not plan on being fully vaccinated by August 2

We respect your privacy. This information is being used for planning purposes only and will not be shared.