[[trackingImage]]

Covid-19 Vaccine Feedback Survey

*For Individuals with Sickle Cell Disease or their Caregivers completing on their behalf Only*

* I understand this request for information is ONLY to capture the COVID-19 Vaccine experience for individuals with Sickle Cell Disease that HAVE RECEIVED the Covid-19 Vaccination.
* What type of Sickle Cell Disease do you have?
0/250
* Age Range:
* Gender
* Which Covid-19 Vaccine did you get?
0/250
* What location did you receive your vaccination?
0/50
* Please Share Your Experience.
0/500
Would you be willing to share your experience with other Individuals with Sickle Cell Disease? If yes please provide us with your name and email address:
0/50
Submit Survey
If you just opted in, you're consenting to receive marketing emails from: SICKLE CELL DISEASE ASSOCIATION OF ILLINOIS, 8108 S WESTERN AVE., , , CHICAGO, IL 60620. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact