Your answers are completely CONFIDENTIAL!!

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

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

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

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

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

* 6. I am a

* 7. My age is

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

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