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COVID-19 and Immunization Questionnaire

Texas State Guard:

This survey is critical to determine the overall deployability readiness of our force at this time of crisis.  You will be asked questions about your exposure to COVID-19 and your current immunization status.

Answer all of the included questions to the best of your ability--if you are unsure whether you have received a certain immunization, select NO.

The information collected through this survey will be used to assess your individual readiness to deploy in support of COVID-19 Response.  Your answers must be as truthful and accurate as possible to avoid unnecessary risk to yourself, your fellow TXSG members, and your friends and family at home.

Thank You,

Darren P. Fitz Gerald
COL, TXSG
Chief of Staff

Rank is required.
First Name is required.
Last Name is required.
Texas State Guard Email Address is required.Must be a valid email address.
Where do you serve is required.
Have you been exposed to someone who has COVID-19 is required.
Are you, or do you have a family member at home who is immuno-compromised due to chemotherapy or HIV or similar health issues; taking medication for autoimmune diseases such as Lupus or Rheumatoid Arthritis; or pregnant is required.
Have you been vaccinated for the Flu Flu shot is required for TXSG. is required.
Have you received a tetanus shot or a vaccination called a DTap, Tdap, or DPT in the last ten (10) years (If you do not know, select NO!) is required.
If yes, when is required.
Have you been vaccinated with Hepatitis B vaccinations (If you do not know, select NO!) is required.
If yes, when is required.
Do you currently have health insurance is required.
If you require vaccination, would you prefer to have the vaccination through our State or local Health Departments or would you prefer to get your vaccination from your primary care physician is required.
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