Post-Survey
Purpose-To evaluate stakeholders on the usage and effectiveness of the Immunization Policy toolkit.
Optional: Name
First Name
Last Name
Optional: Email
example@example.com
Optional: Age
18 to 29
30 to 50
51 to 70
71 to 100
Optional: Sex
Male
Female
Prefer not to disclose
Region where provider practices
*
Urban Region
Rural Region
Suburb
Profession
*
Physician
Nurse
Community Stakeholder
Pharmacists
Other
Working for:
*
Public institution
Private sector
Academia
Self-employed
Other
Type of service you provide
How often are your patients seeking vaccine appointments?
*
Have you used any Immunization/Vaccination Toolkit in the past?
*
Yes
No
If yes, which one?
Do you currently use any Immunization/Vaccination Toolkit now?
*
Yes
No
If yes, which one?
How comfortable are you providing information about PA immunization requirements?
*
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Back
Next
How effective is the Immunization Toolkit?
Very
Somewhat
Effective
Not effective
How relevant is the Immunization Toolkit?
Very
Somewhat
Relevant
Not Relevant
How would you rate the approachability of the Immunization Toolkit?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Submit
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