Effects of the COVID Shot Survey
Name
*
First Name
Last Name
Email
*
example@example.com
In light of the COVID shot being on the market just over five years in December 2025 (and COVID entering our lives six years ago this year), have you or a loved one experienced an adverse reaction or developed a chronic condition or autoimmunity disorder not long after and/or as a result of receiving the COVID shot?
*
Yes
No
If so, please share your story:
Were you or anyone close to you pressured or forced into taking the COVID shot against your convictions or religious beliefs?
*
Yes
No
If so, please share your story:
Will you allow us to use your testimony in our communications and marketing material?
*
Yes (Using first name, last initial)
Yes (Anonymously)
No
Do you want to receive emails from Liberty Counsel with legal updates, news, and analysis?
*
Yes
No
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