1. Surveys
  2. 2016
  3. August
  4. I
  5. Immunization of Children
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Exit Survey
 
 
Hello: You are invited to participate in a survey about Immunization of Children. In this survey, approximately 50 people will be asked to complete a survey that asks questions about immunization of children. It will take approximately 2 minutes to complete the questionnaire. Your participation in this study is completely voluntary and anonymous. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions. Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Brandy Hunter at email at the email address specified below. Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
 
Do you have any children?
 
Yes
 
No
 
Currently Pregnant
 
Currently Trying
 
Other
 
 
 
 
How many children do you have?
   
 
 
 
Were you vaccinated as a child?
 
Yes
 
No
 
Not Sure
 
 
 
Do you plan on vaccinating your children?
 
Yes
 
No
 
Prefer Not Answer
 
 
 
Have you ever been diagnosed with a disease as a child that could have been vaccinated against?
 
Yes
 
No
 
Not Sure
 
Prefer Not Answer
 
 
 
What disease, if any, have you been diagnosed with as a child that had a vaccination (Select all that apply)?
 
Diphtheria
 
Tetanus
 
Pertussis (Whooping Cough)
 
Hepatitis A
 
Hepatitis B
 
Hib – Haemophilus influenzae type b (Hib Meningitis)
 
PCV – Pneumococcal disease
 
Polio – Inactivated polio virus vaccine
 
RV – Rotavirus
 
Measles
 
Mumps
 
Rubella
 
Varicella (Chickenpox)
 
None
 
Not Sure
 
Other
 

 
 
 
What type of Health Insurance do you have?
 
Humana
 
Blue Cross Blue Shield
 
Blue Anthem
 
Aetna
 
Golden Rule
 
Care Plus
 
United
 
Humana One
 
Care Plus
 
Obama Care
 
Medicaid
 
Medicare
 
AARP
 
Passport
 
Kynect
 
Other
 
 
 
 
Are you?
 
Male
 
Female
 
Other
 
 
 
 
About how much do you make annually?
 
0 - 20,000
 
21,000 - 50,000
 
51,000 - 75,000
 
76,000 - 90,000
 
91,000 - 115,000
 
116,000 - 145,000
 
146,000 - 165,000
 
166,000 - 185,000
 
186,000 - 200,000
 
Over 200,000
 
Prefer Not Answer
 
Other