University of Vermont

Adult Immunization Survey

A study organized through the University of Vermont College of Medicine and the Vermont Department of Health

This survey is part of a Public Health Project course for second year medical students at the University of Vermont. Through our survey, we hope to better understand current practices regarding adult immunizations and HIV screening.

Your participation in this survey is completely voluntary. Personal information will not be collected, nor will details about personal medical information be obtained. Please address any questions about this survey to the individual administering it, Nicholas Wilkie at In addition, if you have any questions or concerns, please contact Dr. Jan Carney, the Course Director and Principal Investigator at 656-8275 or

This survey should take no more than 5-7 minutes, and your participation is greatly appreciated. You will receive a summary of the findings after the data have been analyzed.

There are 26 questions in this survey.