1		Gender
		male female
2		Age
		0 - 19 20 - 39 40 - 59 60+
3		Nationality
4		Have you ever been vaccinated against FSME/TBE?
		yes no
		If yes   5A What is the main reason you were vaccinated against TBE? I spend a lot of time outdoors I live in a high-risk area I got it through school/my work/military service To avoid getting sick Other   6A I have received all three primary immunization doses. yes no   7A How many boosters have you received? 0 1 2 3 3+   8A When did you receive your last vaccination? Year:
		If no   5B What is the main reason you have not been vaccinated against TBE so far? No need to, don't live in a high-risk area Never thought about it Haven't received information about it Never go to into the forest Other   6B Do you feel you have received enough information about TBE/FSME? Definitely yes Rather yes Rather not Definitely not   7B How often do you travel through Europe? Once a year Once every six months Once every three months More often   8B Did you know that there were endemic areas for TBE/FSME in most European countries? yes no
I would like to know when my next vaccination is due. Please send me the information by e-mail. E-mail: I would like to receive more information about TBE/FSME. Please send me the information by e-mail. E-mail: I would like to receive the TBE/FSME rubber bracelet by letter. Title: First name: Surname: Street / number: Country Postal code: Town * I agree to my personal data (including my questions) being provided to the expert(s) and/or representative(s) of the support group and to my personal data being saved in anonymous format for further statistical evaluation. I may revoke my declaration of consent for the future at any time.
Please note that information sent by email is at a risk of loss of confidentiality when transmitted over the Internet.
* Mandatory entry

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General Questionnaire