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COVID-19: Client Evaluation Survey

COVID-19 Immunization Clinics: Client Survey

About the Survey

The purpose of this survey is to get your feedback to improve the delivery of COVID-19 immunization clinics.  This information will help us understand the needs of our community to provide better Public Health programs and services.


This survey will take about 10 minutes to complete. If you are completing this survey at the vaccination clinic and have any questions or concerns please contact the nearest volunteer or email the survey team at

If you are completing this survey outside of the clinic (e.g. from home or at work) and have any questions or concerns please email the survey team at

If you have questions about reporting an adverse event related to COVID-19 vaccine(s), call the COVID-19 Info-Line at 905-688-8248 or 1-888-505-6074 press 7.

Please note that the survey cannot be saved in progress.

Risks and Benefits

There are no foreseeable risks from participating in this survey that are greater than those encountered in daily life. But, some questions may be personal, or you may feel some discomfort answering them. You may select "prefer not to answer" or "don't know" for questions you do not wish to answer at any time, without any penalty or consequence. Completion of a survey will provide you the option to enter your email to be entered to win a gift-card.

Personal Information and Privacy

Your confidentiality is important to us and will be respected. All data will be stored securely at Niagara Region Public Health. All information collected, used and disclosed through this survey will be used by Niagara Region in accordance with the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA). Only designated members of the survey team will have access to the data. Only group-level findings of this information will be shared back to Public Health Divisions and community partners to help inform and improve programs and services delivered in the Niagara region. You will have the choice to provide your email to be entered into the prize draw for the gift card, but your email will not be connected to your responses. Please refer any questions related to your Personal Information to our Access & Privacy Office at 905-980-6000 ext: 3770 or 

Electronic consent
Clicking on the “agree” button below means:
1) you have read and understood and
2) you choose to complete this survey.

1. I understand the purpose of the survey and wish to participate voluntarily.   *This question is required.