Form

Smallpox (MVA) vaccination against monkeypox checklist and consent form

Pre-MVA vaccination against monkeypox checklist and consent form.

Applies to England

Documents

Smallpox immunisation consent form (open source version)

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Smallpox immunisation consent form (MS Word version)

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If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@ukhsa.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

Details

Checklist for healthcare professionals when assessing a person for vaccination against monkeypox using the MVA-BN (Modified Vaccinia Ankara – Bavarian Nordic) smallpox vaccine.

The monkeypox vaccination consent form is available in different software versions and is available for download only.

Updates to this page

Published 1 July 2022
Last updated 23 August 2022 + show all updates
  1. Updated the smallpox vaccination against monkeypox checklist.

  2. First published.

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