| Vaccine | Yes | No | Don’t Know |
| Measles | |||
| Mumps | |||
| Rubella | |||
| Tetanus | |||
| Polio | |||
| Hepatitis A | |||
| Hepatitis B | |||
| Human Papillomavirus (HPV) | |||
| Flu vaccine | |||
| Shingles | |||
| Tuberculosis | |||
| COVID-19 | |||
| Other: (please write in) | |||
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