Access to COVID-19 Vaccine and Testing Survey | National Federation of the Blind

Thank you for your interest in submitting this survey; however, this survey is designed to gather feedback from individuals who are blind or low-vision. For more information regarding our COVID-19 resources, please visit https://www.nfb.org/resources/covid-19-resources.

Have you attempted to receive a COVID-19 test? - Optional

Did you encounter access barriers or discrimination due to your blindness? - Optional

In what city and state did the discrimination occur? - Optional

Was the barrier due to an inaccessible website or web form? - Optional

Describe the barrier and its impact. - Optional

Describe the barrier and its impact. This can include discrimination based on other characteristics or religious beliefs as well. - Optional

Have you attempted to receive a COVID-19 vaccine? - Optional

Did you encounter access barriers or discrimination? - Optional

In what city and state did the discrimination occur? - Optional

Was the barrier due to an inaccessible website or web form? - Optional

Describe the barrier and its impact. - Optional

Describe the barrier and its impact. This can include discrimination based on other characteristics or religious beliefs as well. - Optional

Have you reported any incidents of COVID-19 vaccine or testing discrimination to your state or local government? - Optional

What was the nature of your complaint and how did your state or local government respond? - Optional

Please share any additional details, questions, or concerns you have regarding your experience with COVID-19 vaccines and testing. - Optional

Optional Information:

What is your age? - Optional

Contact Information

Follow-up with you may be needed depending on the incidents reported and next steps in challenging incidents of discrimination. Please provide your contact information.

First Name - Optional

Last Name - Optional

Email address - Optional

Phone Number - Optional

Please provide a best time or preferred method of communication - Optional