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Please take a moment to complete our survey on public interest in receiving vaccine for this upcoming flu season. Your responses will help the Municipality to plan for distribution of vaccine for both the "seasonal" flu, and the novel flu virus "H1N1 Swine Flu." Your responses are completely anonymous. For any additional information regarding influenza in our community, or the response to the current influenza outbreak for H1N1 flu, please contact the Department of Health & Human Services at 343-6718, or visit our Influenza information web page at http://www.muni.org/Departments/health/Pages/H1N1SwineFlu.aspx

Thank you for your responses.

Influenza Vaccine Survey


Do you live within the Anchorage city limits?


What is your zip code

Will anyone in your family receive the H1N1 or the seasonal flu vaccination?





If you or anyone in your household fall under any of the following groups, please indicate how many:

Ages 6 months - 18 years
Ages 19-24 years
Lives with or cares for persons under 6 months
Ages 25-64 years with high risk health conditions
Pregnant woman
Health Care or Emergency Personnel

If you plan to receive either the "seasonal" or "H1N1" flu vaccine, where do you plan on getting it from?

Public Vaccination Clinic
Children: from their school
Private Medical Provider
My Workplace
Local pharmacy
Other
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