Employee Flu Clinic Survey
October 17th- Las Cruces Corporate Office 9am-12pm/ October 17th- Border LC 1:30pm-3:30pm/ October 18th- Border EP 11am-3:30pm / October 19th- Escobar 11am-4pm/ October 20th- Chino Dr 11am-3pm This survey is to get an estimated number of employees interested in receiving their flu shot at their employee flu clinic.
Name
*
First Name
Last Name
Email
*
example@example.com
What location are you likely to get your vaccine from?
*
Stagecoach
Escobar
Corporate
Border LC
Border EP
Will you be receiving your flu vaccine at the employee clinic?
*
Yes
No
Do you have insurance?
*
Yes
No
Would you like to fill out your vaccine paperwork in advance? If you select yes, you will receive an email via Jotform with a PDF attachment with our link and QR code.
*
Yes
No
Submit
Should be Empty: