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Questionniare to Staff Regarding Flu Vaccination

Please take 1 minute and answer this quick questionnaire about your willingness to receive a flu vaccination at no charge to you.

Orange Grove will assist you in acquiring a flu vaccination if you are willing to receive one. Please know that you are at risk for exposure to influenza and may be at risk for developing influenza infection. If you decline the influenza vaccine you place yourself and others at risk.

Flu Vaccination

Name 
Email Address 
No, I do not want a flu shot to protect me and the people I serve?
Yes, I would like to have a flu shot to protect me and the people I serve
To prove you are a human, please tell us which is larger?

 

 

This page was last updated on Wed Oct 26, 2016.

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Questionniare to Staff Regarding Flu Vaccination

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Orange Grove Center • 615 Derby Street • Chattanooga, Tennessee 37404 • Phone: 423.629.1451