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HIV Test Request

What is this?

This is a survey to determine if you are eligible to receive a free, at-home HIV test kit from Special Health Resources.
Filling out this survey does not guarantee you will receive a test kit. Participants will know if they are eligible within 2-3 business days upon completion of the survey by email.
1.What is your age?
Test kits are adults, age 18 and older(Required.)
2.Ethnicity: Are you Hispanic or Latino(Required.)
3.What is your race?(Required.)
4.What is your current Gender Identity?(Required.)
5.Has it been more than three (3) months since a risk event?
A risk event could be unprotected sex, needle sharing, a needle stick, etc. The test will be most helpful AFTER 3 months have passed from the event.(Required.)
6.Have you previously had an HIV test?(Required.)
7.How would you describe your sexual orientation?(Required.)