Vaccination Feedback Form

Which vaccination did you have? Required

How was your experience of getting vaccinated? Required

Very positive

Positive

Neither positive nor negative

Negative

Very negative

If you would like to share more detail about your experience, please do so below

Please tell us why you chose to get vaccinated today? (We would like to use your answer in our communications to other Trust colleagues) Required

What name shall we use for you when we share your comment with other colleagues? Please leave this box blank if you want to be anonymous. Alternatively, we could use your first name and job title, role or place of work.

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