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Get tested for FREE at one of our locations!
Thank you for your interest in testing at one of our locations in Arkansas! We collect some basic information below to be able to offer a test to you. Your information is always kept confidential according to strict HIPAA guidelines. If we do not currently have an office location in your area, we will do our best to connect you to a community partner offering free testing in your local community.
Basic Info
First and Last Name
*
First Name
Last Name
Preferred Language
*
English
Spanish
Gender
*
Female
Male
Transgender
Phone Number
*
-
Area Code
Phone Number
Are you able to receive text messages at this phone number?
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Yes
No
E-mail
*
IMPORTANT:
If you have been exposed to HIV by a broken condom, subjected to sexual violence, or shared a needle within the past 48 hours, please contact your doctor or Emergency Room immediately.
Have you been exposed to HIV in the past 48 hours?
*
I have not been exposed in the past 48 hours.
I have been exposed in the past 48 hours.Submit
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Office Location
Please choose the office location that is closest to where you live. If you do not see an office close to you listed, please select other and write the name of your city or town in the box. When we receive your request, we will do our best to connect you to a community partner offering free testing in your local community.
Which EAC office would you like to get tested at?
Fort Smith
Hot Springs
Little Rock - Rodney Parham
Rogers
Texarkana
Testing and Prevention
Have you tested at one of our offices before?
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Yes
No
I don't remember
How long has it been since your last HIV test?
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Less than 1 month
2-6 months
7-12 months
More than 12 months
I have never been tested
What might have put you at risk for HIV? (Check all that apply)
*
Vaginal or anal sex with a female
Vaginal or anal sex with a female without condom
Vaginal or anal sex with a transgender person
Vaginal or anal sex with a transgender person without condom
Vaginal or anal sex with a male
Vaginal or anal sex with male without condom
Injection drug use
Accidental needle stick
Blood Exposure
Sexual activity with HIV positive partner
Your sexual partner engages in condom-less sex with other sexual partners
Your sexual partner uses injection drugs
Which best describes your use of PrEP (Pre-Exposure Prophylaxis?
*
I do not know about PrEP.
I take PrEP sometimes.
I take on-demand PrEP around sexual activity.
I have heard of PrEP, but never taken it.
I take PrEP once a day as perscribed.
I was taking PrEP, but am not now.
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How did you learn about EAC's Testing Program?
*
Google or Online Search
Radio or Podcast
Hulu Ad
Our Website
Facebook Ad or Post
Dating App
Special Event
Brochure or Printed Material
Referred by a friend
Referred by a staff member at EAC
Submission Time
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Year
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AM/PM Option
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