Please spare a few moments to tell us what you think about the COVID-19 vaccine. The NHS is doing everything it can to deliver COVID-19 vaccines in Bath and North East Somerset, but there might be things that can be improved.

We would like to know:
  • What you think about the vaccine programme
  • Whether you would be willing to have the vaccine if you have not already had it and
  • if you have already had the vaccine, what you think about information on the vaccination programme.

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* 1. Which GP surgery do you go to?

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* 2. Thinking of vaccinations in general, such as those given for flu, polio or tetanus is your view of vaccinations... (tick one box)

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* 3. If you were offered a vaccine against COVID-19 (Coronavirus), and at no charge through the NHS, how likely would you be to get vaccinated? (tick one box)

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* 4. If you want to be vaccinated, is there anything that may stop you from receiving a vaccine when it is made available to you? Please tick as many as apply

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* 5. What are the main reasons you want the COVID-19 vaccine? Please tick as many as apply

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* 6. If you would not want to be vaccinated, what would be your motivation for refusing the vaccine? Please tick as many as apply

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* 7. Which of the following are reasons why you decided to be vaccinated against COVID-19? Please tick all that apply

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* 8. Where have you mainly seen or heard information about a COVID-19 vaccine recently?  Please select all that apply.

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* 9. Overall, was the information that you have seen or heard recently

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* 10. Do you agree that information from the NHS or the Government about the vaccine and its roll out has been communicated clearly and effectively?

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* 11. Is there anything else you’d like to tell us about COVID-19 vaccinations?

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* 12. What is the first part of your postcode? (for example BA1)

Please complete the sections about you.  This helps us to make sure we are reaching people in all areas of BANES. However, if you do not wish to answer these questions you do not have to.

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* 13. How old are you?

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* 14. Please describe your ethnic background

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* 15. Please tell us which gender you identify with

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* 16. Is your gender different to the sex that was assigned to you at birth?

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* 17. Please tell us which sexual orientation you identify with:

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* 18. Please tell us about your religion or beliefs:

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* 19. Please tell us about your marital or civil partnership status

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* 20. Are you currently pregnant or have you been pregnant in the last year?

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* 21. Do you consider yourself to be a (family) carer, have a disability or a long-term health condition?  Please tick all that apply

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* 22. If you would like to discuss anything else about health or care services in BANES, please let us have your contact details: name, email phone number and your postcode so we can get back to you.

Thanks for completing our questionnaire.  The information you have given us will be stored on Surveymonkey and used by Healthwatch BANES and Healthwatch England. We anonymise the information and use this as part of our work, highlighting the issues, experiences and views of local people to those who design and manage our local and national health and care services. To find out more about Healthwatch BANES visit our website: https://healthwatchbathnes.co.uk/

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