Vaccination Feedback

Vaccination Feedback
Name

First NameLast Name
Choose Your City*

BhopalDelhiHyderabadJaipurRanchiNashikGoaPunjabIndoreLucknowVaranasiNigeriaLiberiaBangladeshPakistanUSUKAustraliaSingapore
Age*
Vaccination Centre *
Which vaccine was administered at your vaccination centre? *

CovaxinCovishieldModernaSputnik VOther
Which dose have you taken?*

Only firstFirst and Second
How did you schedule your vaccination appointment?*

Arogya Setu appIn-person registrationCoWinother
Was social distancing and mask-wearing maintained at the vaccination site? *

YesNo
How long were you asked to wait at your vaccination centre after getting vaccinated?*

10-20 mins20-30 mins0-15 mins
What were the after effects of vaccine?*
Did you face any difficulties at the vaccination centre due to the staff or was there anything else that concerned you? (Optional)
Do you have any suggestions on how one could book themselves a vaccination slot? (Optional)
Do you have any suggestions on how vaccine related information can be shared more easily? (Optional)
Did the staff inform you about the vaccination process and gave vaccine properly?

YesNo
How long was your wait at the vaccination centre before you received your vaccine?*

15-30 mins30-60 minsMore than 60 minsMore than 120 mins
Was the centre sanitized and disinfected?*

YesNo
How was the treatment by the staff at the vaccination centre? *

GoodBad
Was there professionalism in the staff that gave you the jab?*

YesNo
Was social distancing and mask-wearing maintained at the vaccination centre?*

YesNo
Were you informed about the adverse effects following immunization? *

yesNo
Were you asked to wait for 30 minutes post vaccination for monitoring any adverse event? *

YesNo
Were you satisfied with the overall experience of vaccination?*

YesNo
Was registering for the vaccination an easy one?*

YesNo
Which vaccine did you take?*
Did you face any side effects after taking the vaccine?(If you have just taken the vaccine write 'N/A')*
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