The code block below illustrates how one might use # and // as comments in your logic and calculations.

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Mpox/Smallpox Vaccination Study Interest Form

Thank you for your interest in our Mpox (formerly known as Monkeypox) and smallpox vaccine studies at Baylor College of Medicine. We are currently compiling a list of interested individuals 12 to 50 years of age. If you are interested in participating in an up and coming Mpox/smallpox vaccine study please fill out the form below. If you are under 18 years of age, please have a parent or guardian fill out the form.

Filling out this survey means that you agree that you (or your child) may be contacted about future studies in the Vaccine Research Center (VRC) at Baylor College of Medicine. This survey will collect information such as your name, age, gender, race, if you have been vaccinated against smallpox or Mpox in the past and how we can contact you should a study for which you qualify be available. It should take 2-5 minutes to complete. Although, this information will be kept confidential and only the study team at the VRC will have access to the information, there is a small risk of loss of privacy but we will make every effort to make sure that does not happen. Completing this survey does not mean that you are agreeing to be part of a study, it just means that if a study that you qualify for becomes available, we will reach out to you to see if you would like to participate. By completing this survey, you are giving your consent for the VRC to collect your information. If you have any questions, please contact a member of the VRC at 713-798-4912 or via email at monkeypoxvax@bcm.edu.

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.