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Surveys
2013
September
I
Influenza_Vacc_reporting
Influenza_Vacc_reporting
Inflammatory Bowel Disease Program
University of Michigan
0%
Exit Survey
Annual Influenza vaccination is an important part of your health care.
We appreciate the time you are taking to report your vaccination status.
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Last Name
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First Name
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What is your date of birth?
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2024
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What is your vaccination status?
-- Select --
I HAVE ALREADY RECEIVED the flu shot at a University of Michigan Clinic
I HAVE ALREADY RECEIVED the flu shot outside the University of Michigan
I PLAN ON RECEIVING the flu shot, but have yet to do so
I REFUSE the flu shot
Are any of the following items obstacles or barriers for getting the flu shot ?(Check all that apply)
I don't have the time to get the shot
The shot is too painful
I get flu-like symptoms from the shot
Flu shots are too expensive
I can't find anyone to give me the flu shot
If you have chosen to refuse the flu shot, what is your reason?
-- Select --
I see no benefit
I felt sick after receiving the last flu shot
I have an allergy to the flu shot
Vaccinations are dangerous
I don't have the time
I am unlikely to get the flu
University of Michigan
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