Welcome to Johns Hopkins Online Influenza Questionnaire Form

 
Please click on the link below to answer a few questions about why you declined to receive the influenza (flu) vaccine this season at Johns Hopkins or have received the vaccine from a different healthcare provider.

Johns Hopkins Online Influenza Vaccine Questionnaire Form (formerly called the declination form)

All Johns Hopkins Medicine Physicians, employees, staff and volunteers with a valid Hopkins ID are eligible to receive a free flu vaccine!  However, if you elect to decline the vaccine from Hopkins this season, you will need to complete the online questionnaire. 

For information about vacciniation location sites click here!