COVID-19 Vaccine Questionnaire Header Image

COVID-19 Vaccine Questionnaire

Parent to Parent has been chosen by the Ministry of Health to support whānau caring for disabled family members with up-to-date, reliable vaccine information, and as a channel for feedback from the disability community on issues such as access and administration of the vaccine, and any concerns around vaccination.

Any information you provide below will be used in accordance with the Privacy Act 1993, and will not be associated with any personal details or identifiers. Answers will be collated nationwide and sent to the Ministry of Health only, no individual responses will be provided to the Ministry of Health or any other third party.

Which District Health Board (DHB) region do you live in?*
What is YOUR current vaccination status?*
Do you care for a disabled person 12-years or older?*
Is the disabled person 12-years or older that you care for able to consent to medical decisions?*
What is their current vaccination status?*
Do you care for another disabled person 12-years or older?*
Is the disabled person 12-years or older that you care for able to consent to medical decisions?*
What is their current vaccination status?*
Do you care for another disabled person 12-years or older?*
Is the disabled person 12-years or older that you care for able to consent to medical decisions?*
What is their current vaccination status?*
Powered by Formstack Create your own form