COVID-19 Vaccine Community Survey
Montgomery County would like your feedback so we can continue to provide you and your loved ones with the most useful information and resources during the COVID-19 pandemic and develop a plan for vaccine outreach and distribution. Please note, this survey is completely anonymous and will close on February 4.

The survey takes approximately 5 minutes to complete.  We appreciate your feedback!

For up-to-date information on the COVID-19 vaccine, visit the County's website at www.montgomerycountymd.gov/covid19/vaccine

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1)  Do you plan to get the COVID-19 vaccine?  (If you answer "Yes" please skip to question 4) *
2)  If you answered 'No' or 'Not sure' to the vaccine, why not? Please check all that apply:
3)  If you are unsure about getting the vaccine, what would change your mind?  Please check all that apply:
4)  Where would you be comfortable going to receive the COVID-19 vaccine? Please check all that apply: *
Required
5)  Please check how you self-identify (check all that apply): *
Required
6)  In what languages would you prefer to receive information about COVID-19 vaccinations? Please check all that apply.
7)  Do you identify as: *
8)  What is your age? *
9)  Where do you get your trusted health information?  Please check all that apply. *
Required
10)  If you checked "social media" as an answer on Question 9, please specify which platforms you use.  Check all that apply.
11)  Is COVID-19 a serious health concern for you and your household? *
Please enter your zip code below. *
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