Share your story - Vaccine hesitant

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Health Related Questions:

Please describe your health along with any autoimmune, chronic or related illness symptoms you are experiencing.(Required)

What kind of prescribed medications do you currently take?(Required)

What kind of vitamins/supplements do you currently take?(Required)

Covid-19 Questions:

Did you already have Covid-19?(Required)

Yes

When did you have Covid-19?(Required)

Please explain your symptoms and experiences while sick with Covid-19.(Required)

Since having Covid-19, have you been tested for Covid-19 antibodies?(Required)

Yes

What were the results of your Covid-19 antibody test?(Required)

What factors are influencing your hesitation to be vaccinated for Covid-19? (For example: religious, scientific, consciousness, cultural)(Required)

In Conclusion – Provide a general summary that we can use to introduce your story to our community.(Required)

In order to submit this form, the following must be completed:

Are you interested in having Aimee contact you to schedule an interview-style session to discuss your submission on a recorded video?(Required)

Yes, I am interested.

No, thank you.

What is the best email address or phone # to contact you at?(Required)

We would like to do a follow up on your health in the coming months. When do you want us to reach out to you again?(Required)

I would like to be contacted in 12 months to complete a follow up questionnaire.

I would like to be contacted in 6 months to complete a follow up questionnaire.

PERMISSION: I give permission for AUTOIMMUNE SISTERS to share this information on the @AutoimmuneSisters instagram feed, in instagram stories and/or on their website www.AutoimmuneSisters.org(Required)

Yes, I agree with the permission statement.

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Share your story – Vaccine hesitant

Health Related Questions:

Covid-19 Questions:

In order to submit this form, the following must be completed:

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Reduce Inflammation

Autoimmune Disease List

Learn From Us

Is Your Doctor a Good Fit?

ESTABLISHED OCTOBER 2018

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Autoimmune Sisters

Health Related Questions:

Covid-19 Questions:

In order to submit this form, the following must be completed:

Form Preview

Reduce Inflammation

Autoimmune Disease List

Learn From Us

Is Your Doctor a Good Fit?

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ESTABLISHED OCTOBER 2018

Blog Topics

Resources

Autoimmune Sisters