Vaccination Feedback- Vizag
Name
First Name
Last Name
Age
*
Vaccination Centre
*
Which vaccine was administered at your vaccination centre?
*
Covaxin
Covishield
Moderna
Sputnik V
Other
Which dose have you taken?
*
Only first
First and Second
How did you schedule your vaccination appointment?
*
Arogya Setu app
In-person registration
CoWin
other
Was social distancing and mask-wearing maintained at the vaccination site?
*
Yes
No
How long were you asked to wait at your vaccination centre after getting vaccinated?
*
10-20 mins
20-30 mins
0-15 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?
Yes
No
How long was your wait at the vaccination centre before you received your vaccine?
*
15-30 mins
30-60 mins
More than 60 mins
More than 120 mins
Was the centre sanitized and disinfected?
*
Yes
No
How was the treatment by the staff at the vaccination centre?
*
Good
Bad
Was there professionalism in the staff that gave you the jab?
*
Yes
No
Was social distancing and mask-wearing maintained at the vaccination centre?
*
Yes
No
Were you informed about the adverse effects following immunization?
*
yes
No
Were you asked to wait for 30 minutes post vaccination for monitoring any adverse event?
*
Yes
No
Were you satisfied with the overall experience of vaccination?
*
Yes
No
Was registering for the vaccination an easy one?
*
Yes
No
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')
*
Submit
Should be Empty: