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GHANA UNITED METHODIST CHURCH
CHRIST NTI YEYE ADEHYIE
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GUMC-BRONX VACCINE SURVEY FORM
GUMC COVID-19 VACCINE SURVEY FORM
Please answer this brief anonymous survey on behalf of the GUMC Health Ministry
Please complete only 1 survey per member
Have you received the COVID Vaccine
Yes, I am fully vaccinated
I am partially vaccinated (received only 1 dose)
No, I have not been vaccinated
If you have not been vaccinated, what is/are the reason
I do not trust the vaccine
I do not have enough information
I do not know where to get the vaccine
I do not want the vaccine
I do not have insurance
Other
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