Survey

Thank you for providing your feedback on your child’s vaccination experience with FluMist® below

We will not request any personal or identifiable information from you in this survey.

If you have any concerns about your child or their response to the vaccine, please contact our nursing team on (08) 9316 3535 or book an appointment with your doctor. For life threatening emergencies, please dial 000 for an ambulance.

PLEASE DO NOT PROVIDE ANY PERSONAL OR IDENTIFIABLE INFORMATION ON THIS FORM

About Your Child

What age is your child*

Vaccination details

Has your child had an influenza vaccination in a previous year?*

When did your child receive the FluMist® vaccine?*

Is this the first time your child has received the FluMist® vaccine?*

What were the main reasons you chose FluMist® for your child?*

How informed did you feel about FluMist® before your child received it?*

Experience during vaccination

How did your child tolerate the FluMist® vaccine at the time of administration?*

Compared to injectable vaccines, how stressful was FluMist® for your child?*

Side Effects

Did your child experience any side effects within 7 days of vaccination?*

How would you rate the overall severity of any side effects?*

Satisfaction and Future Intentions

Overall, how satisfied are you with your child's FluMist® experience?*

Would you choose FluMist® again for your child in the future?*