Mpox Vaccine Screening and Consent Form Template Posted on October 12, 2022February 24, 2023 by ☰ MENU MpoxSigns and SymptomsRisks and TestingPreventionVaccinationTreatmentsData in VirginiaHealthcare ProvidersCommunications Resources Resources Audience Resource Type Source Languages Mpox Homepage Mpox Private Provider Screening and Consent Form Template (Word doc) (2pp, 49KB) Categories: Audience Guidance Documents Healthcare Resource Type Resources Opens pdf or document to download Opens in a new window External link will open in a new window. Click link to exit Virginia Department of Health Website.