The HELP Center for LGBT Health and Wellness is a new program operated by the Health Education Learning Project. The Center's first program is a clinic that makes it possible to receive PrEP services at NO COST to you. That's right... there is no cost for seeing a provider, no cost for your labs and no cost for the medications!  The clinic will be open on Tuesday evenings and Saturday mornings.  We will begin seeing patients on July 11th.  The Center will add additional medical and social services in the future to address the health and wellness needs of our community. 

Please complete the following form if you would like an appointment or want to discuss accessing PrEP services more. We will contact you back within 2 business days after receiving the form.  

If you cannot complete this form, you may call our office at 817-332-7722 during normal business hours. 

Question Title

* 1. The Centers for Disease Control protocol indicates that PrEP may be a good option for gay/bisexual men and/or individuals in a sexual relationship with someone living with HIV/AIDS.  Do one of these apply to you?

Question Title

* 2. First Name: 

Question Title

* 3. Last Name:

Question Title

* 4. Street Address:

Question Title

* 5. City:

Question Title

* 6. State:

Question Title

* 7. Zip Code:

Question Title

* 8. Phone Number:

Question Title

* 9. Is this a 

Question Title

* 10. Email Address:

Question Title

* 11. Confirm Email Address:

Question Title

* 12. How do you prefer to be contacted?

Question Title

* 13. Leaving messages - Can we: (check all that apply)

Question Title

* 14. Do you have medical insurance that includes medication coverage? (You do not need insurance for our program)

Question Title

* 15. Thank you for your interest in our new PrEP program.  We will be in contact with you shortly.   Please provide any additional information in the box below. 

T