Javascript is required to load this page.
Page Loaded
Please
select the statement
that most closely applies to you.
Note that
your responses are anonymous
unless you request assistance with securing a vaccine appointment (statement #4) and choose to provide contact information.
I have been
fully vaccinated
(completed either
one dose of a one-dose vaccine — 1/1
or
both doses of a two-dose vaccine — 2/2
)
I have been
partially vaccinated
(completed
one dose of a two-dose vaccine — 1/2
)
I have
not been vaccinated
and
have an upcoming appointment
for vaccination
I have
not been vaccinated
and
would like to get an appointment
for a vaccination
I have
not been vaccinated
and
am not interested in being vaccinated
Has it been
two weeks or longer
since you’ve received your last vaccine dose?
Yes
Maybe
No
To assist you in obtaining an appointment, please enter your information below.
Full Name
Email Address
Personal Telephone#
Mobile Phone#
Stony Brook ID#
For any technical questions or accessibility accommodations related to this survey, please contact
ahmed.w.belazi@stonybrook.edu
Powered by Qualtrics