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Survey Templates Surveys HPV

HPV

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School Code: What is the gender of your child in Year 7/8? MALE FEMALE Have you heard of the HPV vaccine? YES NO If YES, please select where you got most of your information from the following options: Media (TV, Newspaper, Radio) Family or friends Health Services (GP, Hospital, Health Centre) School Internet Other Do you agree with the following (please tick one box)? I am happy with the information I have received on the HPV Vaccine Strongly Agree Agree No Opinion Disagree Strongly Disagree I understand the information I have received on the HPV vaccine. Strongly Agree Agree No Opinion Disagree Strongly Disagree I have not received any information I would like more information on the HPV Vaccine. Strongly Agree Agree No Opinion Disagree Strongly Disagree Would you allow your child to have the HPV Vaccine? YES NO Don't Know If NO, why? (please tick one of the following reasons): I have not received enough information to make a decision I am worried that it may harm my child I don’t believe it works I think my child is too young I think it may encourage sexual activity My religious/cultural beliefs do not support the vaccine I don’t think my child is at risk of HPV I don’t know Other (please state): Please tick one box that applies to you about your age Less than 30 30-39 40-49 50-59 60+ Your Gender: MALE FEMALE What is your ethnicity? What is your religion?

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