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HIV Self-Testing Kits

Privacy Policy: Wellness in Action is a partnership between Arianna's Center and the Human Rights Campaign Foundation (HRCF). Responses will be used only for data analysis and evaluation purposes, and in ways that will not reveal your identity. Your responses will help us to ensure we are meeting the initiatives HIV testing, PrEP and treatment goals and allow us to actively make improvements to the "Wellness in Action" initiative as needed.
1.Name(Required.)
2.Phone number(Required.)
3.Race/ethnicity(Required.)
4.Sexual Orientation(Required.)
5.Gender identity(Required.)
6.Age Group(Required.)
7.Zip code(Required.)
8.How did you hear about the self-testing kit?(Required.)
9.If you did not receive a testing kit in person, do you need one shipped to your home?(Required.)
10.If you answered yes in the previous question, please provide your shipping address
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