The Virginia Department of Health (VDH) developed this survey to gauge interest from community members who may be at a greater risk of exposure to monkeypox. This information will be used to determine monkeypox vaccine eligibility, based on certain characteristics. THIS IS NOT PRE-REGISTRATION FOR A VACCINE AND COMPLETING THIS FORM DOES NOT GUARANTEE YOU WILL GET A VACCINE. If you are eligible for vaccination, a representative from the Virginia Department of Health (VDH) will contact you to further discuss.
If you are not eligible at this time, you may visit back at a later time when you may become eligible. This interest form is for Virginia residents only. If you live in another state, please check with your local health department.
Vaccine will be made available to each eligible individual based on risk factors and no one will be denied a vaccine based on race, gender, sexual orientation, religion, economic, and citizenship status.
This survey is HIPAA compliant, meaning your personal and health information is protected and kept confidential. You do not need to fill out this form more than once.