2023 Gold Coast immunisation clinic QIS - Introduction - Gold Coast Hospital and Health Services

1. Do you identify as an Aboriginal or Torres Strait Islander person?

(Required) No Yes, Aboriginal Yes, Torres Strait Islander Yes, both Aboriginal and Torres Strait Islander

2. What's the age of the person getting a vaccine here today? (If more than one in your family group getting vaccinated today, answer for the youngest)

(Required) <1 year old 1 - <2 years old 2 - <5 years old 5 - <12 years old 12 -17 years old 18+ years old Prefer not to answer

3. What is your postcode?

Postcode (Required)

4. What is your suburb?

Suburb (Required)

5. Which clinic are you attending today?

Clinic location (Required)

6. Is a child under your care getting a vaccine here today? (If yes, continue to question 7. If no, continue to question 12)

(Required) Yes No