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Covid-19 Vaccine Interest Survey

*For Individuals with Sickle Cell Disease (SCD) or their Caregivers Only*

* I understand this survey is to capture if I (an individual with Sickle Cell Disease)-or-(my child with SCD; age 16 & over) has a interest in receiving the COVID-19 Vaccination and HAS NOT already received the vaccination.
* What type of Sickle Cell Disease do you have?
0/250
* Age Range:
* Gender
* Are you interested in receiving the Covid-19 Vaccination?
0/250
If you want to receive the vaccine, which Covid-19 Vaccine are you interested in?
0/250
* Please Share Your Questions or Concerns.
0/500
If you would like a staff member to reach out to address any questions or concerns you have please provide us with your name and email address:
0/50
Submit Survey
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