best Shot Questionnaire 
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Email *
Name *
Age Range *
Phone number
 Region of Texas *
 Please select one option that best describes you.
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 Have you been vaccinated against COVID - 19? *
What is preventing you from finishing the vaccine series?
 Where do you get your information about the vaccine?” *
Why did you or didn’t you get vaccinated? *
If you had COVID, do you have any on going side effects?  If yes, what are they?
 Do you feel more comfortable going out into the community since you have fully vaccinated with/without the booster?  If yes, what does  your new normal look like? *
  Did you have any hesitancy to get the COVID vaccination?  If yes, what were you hesitant about and how did you overcome it? *
If you were eager and just waiting for your turn to get vaccinated, why were you for certain and trustworthy of the vaccination? *
 If you are fully vaccinated and still got COVID, how many days did you test positive? What were your symptoms and how long did they last?   *
How have you been affected by COVID-19? Please select all that apply
When receiving your shot, were there any accessibility barriers? Was the clinic sensory friendly, physically accessible, with understandable communication, etc.
Do we have permission to include your responses in our marketing materials? *
I give Best Shot Texas, a project of the TCDD, permission to contact me by phone or email *
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