Contact Information
First Name Last Name Phone Number Email Address   
Screening Questions
The following questions will help us determine if there is any reason you should not receive the JYNNEOS vaccine at this time. If you have experienced severe anaphylactic reactions especially to prior vaccines or injectable drugs, you should discuss risks with your doctor before receiving the vaccine. If a question is not clear, please email the Somerset County Department of Health at
1. Are you at high risk of having had a potential recent exposure to monkeypox (within the past 14 days)? This may include intimate, skin-to-skin contact, with others in areas where monkeypox is spreading.
2. Do you feel that you may be at risk of future exposure to monkeypox, even though you are not at high risk of a recent exposure to monkeypox within the past 14 days?
3. Are you 18 years and older?
4. Are you currently pregnant, planning to become pregnant, or breastfeeding?
5. Have you read and reviewed the Vaccine Information Statement (VIS) for the JYNNEOS vaccine? (JYNNEOS dates 6/1/22)
6. Do you have three or more of the following major cardiac risk factors to include hypertension, diabetes, hypercholesterolemia, heart disease at age ≤50 years in a first-degree relative, or smoking?