Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Movie Theater Ad Survey

  1. Lenawee County Health Department - Movie Theater Ad Survey
  2. Have you been to the Adrian Cinema to see a movie since January 1, 2019? *
  3. Did you see any of our immunization advertisements? They run on the screen immediately before the previews.
  4. Which advertisement did you see? Check all that apply.
  5. Thank you!
    For more information about the health department's immunization program, visit: http://www.lenawee.mi.us/233/Immunization
  6. Leave This Blank:

  7. This field is not part of the form submission.