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Monkeypox Vaccine Request

Ontario continues to monitor for cases of MPOX (formerly known as monkeypox) and is working collaboratively with health care providers, Public Health Ontario (PHO) and the Public Health Agency of Canada (PHAC) to address health risk(s). Given the current epidemiology in Ontario, Imvamune® should be offered as a two-dose primary series, with at least 28 days between first and second doses for individuals currently eligible for pre-exposure or post-exposure vaccination.

The request form below is only for eligible individuals seeking Pre-Exposure vaccination (when the vaccine is provided before known exposure to the virus). If you have been exposed or developed symptoms, please call Health Connection at 705-721-7520 or 1-877-721-7520, ext. 8809, Monday to Friday, 8:30 a.m. to 4:30 p.m. or contact your health care provider.

Additional information regarding MPOX is available on the Gay Men's Sexual Health Alliance website.

Please complete the fields below:

Please note required fields are marked with an * Asterisk.

* I would like to be put on the list to receive this vaccine and understand I will be contacted by SMDHU.
YYYY-MM-DD , for example (1980-01-21)
Enter numeric values only with no dashes or spaces (i.e.,9999999999)
If you don't have an Ontario Health Card Number please enter all zero's (i.e. 0000000000)

If you do not live in Simcoe County or the District of Muskoka, please follow up with your local Public Health Unit

Please confirm your eligibility here prior to submitting the request form.

* Please indicate which dose you are requesting:

“The Health Unit collects personal information in the course of doing business. Personal information about you is collected directly from you or from the person acting on your behalf. Personal health information collected may include, for example, your name, date of birth, address, contact information, health card number, health history, and information you provide during visits or calls to the health unit.”

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If you have any questions or concerns that require a response, please contact Health Connection directly.

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