MPV Appointment Request
This from is for CAMBA's MPV Vaccine Portal. If interested in the MPV Vaccine or information about the vaccine, please fill out this form to be linked with a CAMBA outreach worker. See below for eligibility for the MPV Vaccine: 
The following groups are currently eligible:

People who are 18 or older, have had multiple or anonymous sex partners in the last 14 days, and identify as at least one of the following:
  • Gay, bisexual, or other man (cisgender or transgender) who has sex with men (cisgender or transgender) or transgender women
  • Transgender, gender non-conforming or gender non-binary people
  • Sex workers and anyone engaging in survival sex or any other types of transactional sex (including sex in exchange for money, food, shelter or other goods) of any sexual orientation or gender identity.
  • People who have been informed by the Health Department that they are a close contact of someone with MPV.
Because slots are limited, submitting this form does not guarantee an appointment. Please email YMHP@CAMBA.ORG for any questions. You will need to bring a photo ID with you - please contact us if you do not have any form of identification. 

Email *
What is your name? *
(If different that above) What is your name as is appears on your ID
What are your pronouns? *
What is your date of birth *
MM
/
DD
/
YYYY
What is your phone number? *
What is your address? (including zip code) *
What is your sexual orientation? *
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