This survey gives you the opportunity to tell us about your experience of your recent immunisation session.

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* 1. Name of your school:

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* 2. Which borough or county is your school in?

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* 3. What school year are you in?

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* 4. Date of vaccination

Date

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* 5. Do you know what vaccination you received that day?

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* 6. Please choose the option that best describes this statement.
I was given information about the vaccine before I received it.

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* 7. Before you had the vaccine, did you have any questions for the nurse?

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* 8. If  you had a question for the nurse before your vaccine, did the nurse answer it clearly in a way that you could understand?

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* 9. How friendly were your nurse and the other immunisation staff?

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* 10. Did you return a consent form to your school signed by your parent or carer?

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* 11. If you did not have a consent form signed by a parent or carer, and you gave consent for yourself to have the vaccine, how did that process make you feel?

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* 12. Would you like to tell us anything else about your experience on the day of the vaccination session?

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