LETS RATE OUR HEALTH Please enable JavaScript in your browser to complete this form.Name (Optional)FirstLastGender *MaleFemaleAge *Zip Code *Email- We email results of the survey. *How many Covid-19 Vaccines injections, including boosters, did you receive? *6543210How many times did you get diagnosed with Covid-19? *43210Did your health improve after taking the Covid-19 Vaccine? *Yes NoTemporaryN/AHow would you rate the medical industry performance during Covid-19? *Very satisfiedSatisfiedNeutralUnsatisfiedVery UnsatisfiedHow would you rate the U.S government's performance of managing Covid-19? *Very satisfiedSatisfiedNeutralUnsatisfiedVery UnsatisfiedHow would you rate your overall Health prior to Covid-19? *ExcellentGoodOkNot goodTerribleHave you had any serious illness in 2021 and/or 2022? *NoBlood ClotsHeart ProblemsBrain IssuesSevere Allergic ReactionOtherHow would you rate your overall Health now? *ExcellentGoodOkNot goodTerribleHow would you rate your Mental Health prior to Covid-19? *ExcellentGoodOkNot goodTerribleHow would you rate your Mental Health now? *ExcellentGoodOkNot goodTerribleHas anyone in your family died within a week after taking the Covid-19 Vaccine? *Yes NoHave you had any adverse effects from the Covid-19 Vaccine? *YesNoDo you feel the Covid-19 Vaccine is *HelpfulHarmfulSubmit 1STREAM.TVProduce Podcasts, Stream Seminars, View Content We promise not to spam you. You can unsubscribe at any time. Invalid email addressThanks for subscribing!