Step 1 of 3 33% The Montgomery County Health Department has received Monkeypox Vaccine. Monkeypox vaccine supply is limited at this time, HOWEVER, the criteria for who can be vaccinated has been expanded. Please see the criteria below to see if you qualify: 1. Men who have sex with men over the age of 18, including those who identify as gay, or bisexual, or transgender, or gender nonconforming, or gender nonbinary. AND a.) Have had multiple or anonymous male, transgender, or gender non-conforming sex partners in the last 14 days, OR b.) Had a diagnosis of gonorrhea or early syphilis in the last 12 months, OR c.) Are on HIV pre-exposure prophylaxis (PrEP) OR 2. Persons who attended an event/venue where there was a high risk of exposure to an individual(s) with CONFIRMED monkeypox through skin-to-skin or sexual contact in the last 14 days. OR 3. Has had high risk contact (skin to skin or other direct/close contact) to someone with CONFIRMED Monkeypox in the last 21 days. If you feel you meet one of these criteria, please continue with the confidential survey. Once you have completed the survey, a dose will be reserved and you will be contacted by phone within 48 hours for an appt at our clinic, MONTGOMERY COUNTY HEALTH DEPARTMENT. Please list a reliable phone number. If we are unable to reach you within 24 hours of initiating contact, your reservation may not be held. The survey will close once all doses have been reserved. If you have questions about Monkeypox vaccination, you may call 859-498-3808 or visit: montgomerycountyhealth.com/1. Anyone who has had close contact to someone with known or suspected monkeypox virus (direct skin-to-skin contact or other close contact) 2. Anyone who has a diagnosis of HIV. 3. Anyone who has had chlamydia, gonorrhea, or early syphilis within the last 12 months. 4. Anyone who is taking medication to prevent HIV infection (PrEP) 5. Anyone who exchanges sex for money or nonmonetary items 6. Anyone who has attended an event/venue where there was a high risk of exposure to an individual/s with Monkeypox virus through skin-to-skin or sexual contact. 7. Gay, bisexual or other men who have sex with men or transgender people who are sexually active. 8. Laboratory workers who routinely perform monkeypox or orthopox virus testing. 9. Healthcare professionals who have had high-risk occupational exposure without using recommended personal protective equipment in the past 14 days. If you feel you meet one of these criteria, please continue with the confidential survey. Once you have completed the survey, you will be contacted by phone within 48 hours for an appt at our clinic, MONTGOMERY COUNTY HEALTH DEPARTMENT. Please list a reliable phone number. If you have questions about Monkeypox vaccination, please call us at: 859-498-3808 or visit: montgomerycountyhealth.com/ Please reread the criteria for vaccination below and select all that apply to you:HiddenI am a man who has sex with men (and may identify as gay, bisexual, or transgender, or gender nonconforming, or gender nonbinaryAND a.) Have had multiple or anonymous male, transgender, or gender non-conforming sex partners in the last 14 days, OR b.) Had a diagnosis of gonorrhea or early syphilis in the last 12 months, OR c.) Am on HIV pre-exposure prophylaxis (PrEP) HiddenI am a man who has sex with men (and may identify as gay, bisexual, or transgender, or gender nonconforming, or gender nonbinary(Required)AND a.) Have had multiple or anonymous male, transgender, or gender non-conforming sex partners in the last 14 days, OR b.) Had a diagnosis of gonorrhea or early syphilis in the last 12 months, OR c.) Are on HIV pre-exposure prophylaxis (PrEP) Yes N/A HiddenI attended an event/venue where there was a high risk of exposure to an individual(s) with CONFIRMED monkeypox through skin-to-skin or sexual contact in the last 14 days. Yes HiddenI attended an event/venue where there was a high risk of exposure to an individual(s) with CONFIRMED monkeypox through skin-to-skin or sexual contact in the last 14 days.(Required) Yes N/A HiddenI had high risk contact (skin to skin or other direct/close contact) to someone with CONFIRMED Monkeypox in the last 21 days. Yes HiddenI had high risk contact (skin to skin or other direct/close contact) to someone with CONFIRMED Monkeypox in the last 21 days.(Required) Yes N/A I attest that I meet one of the listed criteria for receiving the monkeypox vaccine.(Required) I attest that I meet one of the listed criteria for receiving the monkeypox vaccine.(Required)I am over the age of 18 years of age.(Required) I am over the age of 18 years of age.(Required) Name(Required) First Last Phone(Required)County of Residence(Required) HiddenDate of Birth(Required) MM slash DD slash YYYY HiddenAddress(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
