Your answers are completely CONFIDENTIAL!!

Question Title

* 1. Have you had unprotected sex in the last 6 months?

Question Title

* 2. Are you aware of Health Clinics in your area?

Question Title

* 3. Have you been tested for a STI/STD or HIV in the past six months?

Question Title

* 4. Do you believe you may be pregnant or have gotten someone pregnant?

Question Title

* 5. Are you interested in receiving more information about protecting your health?

Question Title

* 6. I am a

Question Title

* 7. My age is

Question Title

* 8. What is your ethnicity? (Please select all that apply.)

T