An Mpox (formerly Monkeypox) self-screening questionnaire is a medical form used by medical facilities to screen patients for mpox - a disease with symptoms similar to those of smallpox. An mpox self-screening questionnaire aims to collect information from potential patients about whether they have been exposed to the disease. Just enter your personal contact info, customize the questions, and post the form to your website or share it with a link.
Need to make this questionnaire match your practice? You can upload your logo or a different background image, add your contact info, and make any other necessary adjustments using Jotform’s powerful Form Builder. And with Jotform Mobile Forms, you can use your tablet or phone to collect responses on the go. If you want to automatically store responses in your other accounts, add an integration with Jotform and more. If you want to keep your patients’ information private, you can use Jotform to protect it with HIPAA friendly features. Protect your practice — and your patients — with a free Mpox Self-Screening Questionnaire.