PrEP Assessment

1

Do you have sex without a condom?

YESNO

2

Do you have multiple sex partners?

YESNO

3

Do you use injection drugs?

YESNO

4

Are you having sex with someone who does not know their HIV status?

YESNO

5

Are you having sex with someone who is HIV+?

YESNO

6

Do you participate in sex work?

YESNO

7

Qualified

Yes

No

8

PrEP is a pill you take daily to reduce your risk of contracting HIV. There are many other ways to reduce the risk of HIV transmission as well. If you would like to set up a time to talk with our team about your HIV prevention options, click Next.

9

PrEP could be right for you! If you would like to schedue a free and confidential PrEP Consultation, please click Next.

10

What is your name?

First Name

Last Name

11

What is your phone number?

Area Code

Phone Number