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  2. 2016
  3. May
  4. V
  5. Vaccine Survey for Parents
0%
Exit Survey
 
 
How did you hear about the elimination of Vaccine exemptions?
 
New Media (TV, Internet, Radio, etc.)
 
Social Media
 
Flyer or Pamphlet from your child's school
 
From your child
 
From other parent
 
Other
 
 
Do you agree with mandatory vaccine for children (except for medical reasons i.e. allergic)?
Strongly Disagree Somewhat Disagree Neither Agree nor Disagree Somewhat Agree Quarterly Strongy Agree
Feelings
 
 
 
Was your child or children current with all CDC recommended vaccines prior to the new regulations?
 
All Children
 
Some of my Children
 
None of my children
 
Unsure or Don't Know
 
Other
 
 
 
 
Do you plan on homeschooling your children in the future as a result of the new regulations?
 
Yes
 
No
 
Unsure
 
 
Do you feel that vaccines are safe for children?
Definitely Not Safe Somewhat Not Safe Unsure Somewhat Safe Very Safe
Vaccines Safe?
 
 
 
Do you feel the community safer from disease outbreaks with the new regulations?
 
More Safe
 
No Change
 
Don't know/Not Sure
 
 
 
Did your child get vaccinated at their school?  If so, please provide feedback on the experience.
 
No
 
Yes, Provide Feedback:
 
 
 
Do you have any concerns regarding these new regulations?
 
No
 
Yes
 
 
 
What is your gender?
 
Male
 
Female
 
Prefer not to answer
 
 
 
What is your age?
 
Younger than 18
 
18 - 24
 
25 - 34
 
35 - 44
 
45 - 54
 
55 - 64
 
65 or older
 
Prefer not to answer
 
 
 
What best describes your employment status?
 
Employed full-time
 
Employed part-time
 
Self-employed
 
Unemployed, looking for work
 
Unemployed, not looking for work
 
Student
 
Retired
 
Homemaker
 
Military
 
Prefer not to answer
 
Other
 
 
 
 
Which of the following categories best describes your annual income?
 
Under $15,000
 
$15,000 - $29,999
 
$30,000 - $44,999
 
$45,000 - $59,999
 
$60,000 - $74,999
 
$75,000 - $89,999
 
$90,000 or more
 
Prefer not to answer