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Your action plan

Think about what you just learned about COVID-19 and the COVID-19 vaccine. Answer the questions below, and then download or print your summary.

Share these resources with your health care team to discuss your decision about COVID-19 vaccination. The decision is ultimately yours, and you can connect with your health care team when you are ready.

1. Do you understand how the COVID-19 vaccines work?

Yes, I generally understand

Not sure

No, I need more information

2. Do you understand how the COVID-19 vaccines can help you?

Yes, I generally understand

Not sure

No, I need more information

3. What are reasons for you to get a COVID-19 vaccine? Check the ones that apply to you:

I have work or school that would be disrupted by sick time if I were infected by COVID-19.

I have a job that puts me in contact with other people, such as in health care or a school, and increases my risk for COVID-19.

I want to help protect family, friends, and coworkers from getting sick with COVID-19.

I am healthy and want to stay healthy.

I am pregnant, and I want to protect myself and my child from COVID-19.

I have a health condition that puts me at high risk for serious illness from COVID-19.

I am part of a community that has been affected more by COVID-19.

I live with someone who is at high risk for serious illness from COVID-19.

I am over age 65 or I live with someone over age 65.

Other:

4. Do you plan to get and stay up to date with a COVID-19 vaccine?

Yes, definitely

I think so

Not sure

I don't think so

No, definitely not

5. When and where will you get your COVID-19 vaccine? Go to Find a VA location or visit Vaccine Finder. You can also text your ZIP code to 438829 or call 800-232-0233 to find COVID-19 vaccination locations in your community. Write your location here:

6. Do you have questions for your health care team? Check any questions you want to ask:

What is my level of risk for getting COVID-19?

What is my risk of having a serious illness from COVID-19?

What are possible side effects of the vaccine for me?

Are there any reasons I shouldn't get a COVID-19 vaccine?

Where is the best place for me to get a COVID-19 vaccine?

Which COVID-19 shot should I get?

Can you give me a COVID-19 vaccine today?

> I don't need to ask any questions

7. What other information do you need or would like to share with your health care team? If you have nothing to share, enter N/A.

No personal information is stored when completing this document. If you would like to go back to the COVID-19 vaccine tool, close this tab or window.

Your COVID-19 vaccine action plan

You just learned about COVID-19 and how the COVID-19 vaccine works. You thought about your reasons for getting a COVID-19 vaccine. Below are your answers from the questions you just considered, and your next steps.

1. Do you understand how the COVID-19 vaccines work?

You answered:

To learn more about the COVID-19 vaccines, go to Vaccines for COVID-19.

2. Do you understand how the COVID-19 vaccines can help you?

You answered:

To learn more about the benefits of the COVID-19 vaccines, go to Benefits of Getting a COVID-19 Vaccine.

3. What are reasons for you to get a COVID-19 vaccine?

You answered:

4. Do you plan to get a COVID-19 vaccine?

You answered:

5. When and where will you get your COVID-19 vaccine? Sign up at Sign Up to Get a COVID-19 Vaccine at VA or visit Vaccine Finder. You can also text your zip code to 438829 or call 800-232-0233 to find COVID-19 vaccination locations in your community.

You answered:

6. Do you have questions for your health care team?

You answered:

7. What other information do you need or would you like to share with your health care team?

You answered:

No personal information is stored when completing this document. Want to keep this questionnaire for future reference or share with your health care team? Print your responses by clicking on the print icon in the upper-right-hand corner of the screen. Now that you've completed these questions, close this tab to go back to the COVID-19 vaccine tool.

Date Last Reviewed: 10/1/2020