MONKEYPOX VACCINE Eligibility/SCREENING form

Anchor Health has been selected as one of 13 sites in Connecticut to administer the Jynneos monkeypox vaccine. Due to extremely limited supply, vaccination is prioritized for individuals at the highest risk of exposure to someone with monkeypox.

To be considered eligible for the vaccine, individuals must live in Connecticut, including as a student or trainee, and show proof of residence, e.g., a valid photo ID or piece of mail addressed to you.

Individuals who meet at least one of the following criteria are eligible for the monkeypox vaccine:

  • Had a sexual partner in the past 6 months who was diagnosed with monkeypox;
  • Had multiple sexual partners in the past 6 months in a jurisdiction (e.g., city/state/country) with known monkeypox.
  • Have a current partner who has multiple sexual partners in a jurisdiction with known monkeypox.
  • Anticipate having a new sexual partner or partners in the next 6 months in a jurisdiction with known monkeypox.

More information about considerations for the monkeypox vaccine is available through the Connecticut Department of Public Health’s monkeypox webpage.

The vaccine is free, and no insurance is required.

Vaccine screening

If you meet the eligibility criteria, please fill out the screening form below. Please note that we are contacting and scheduling eligible individuals in the order that they are received.

Please do not use this form if you have had exposure to a lab-confirmed case of monkeypox. Please call 203-903-8308 to speak with a medical provider right away. Delays in response to this form may impact your care. If you are experiencing a serious or life-threatening emergency, call 911 or go to the nearest emergency room (ER) for care.