Us Helping Us HIV/STI Self-Test Kit Request Form

Thank you for taking control of your sexual health by requesting an HIV/STI self-test kit. By completing this request, you consent to have a Community Health Worker from Us Helping Us to contact you about your request, answer any questions you may have about the self-test kit, follow up with you about your HIV/STI test results, and link you to PrEP (pre-exposure prophylaxis), PEP (post-exposure prophylaxis), or HIV treatment, if needed. All answers that you give will be kept private and confidential. Your participation is voluntary, and you may withdraw at any time without penalty, prejudice, or loss of benefits and services at Us Helping Us.

Note: The HIV/STI Self-Test Kit includes an oral rapid HIV test, Syphilis self-test kit, and swabs/urine cup to test for gonorrhea and Chlamydia.