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For each vaccination below, please indicate if you have heard of it:
Which of the following vaccinations have you been eligible for in the past 12 months? (Tick all that apply)
Which of the following vaccinations did you receive in the past 12 months? (Tick all that apply)
Which of the following vaccinations were you eligible for but did NOT receive in the past 12 months? (Tick all that apply)
What would make you more likely to receive vaccinations in the future? (Only answer if you did not receive some vaccinations, you were eligible for)
Where did you receive your most recent vaccination?
Do you agree or disagree with the following statements about vaccination
To what extent do you agree or disagree with the following statements about keeping up with recommended vaccinations?
If you did receive any vaccinations, what motivated you to do so? (Tick all that apply)