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Welcome

Before you proceed, please note that the free testing Kit provided is exclusively for individuals who are seeking PrEP (Pre-Exposure Prophylaxis). If you are looking for testing unrelated to PrEP, we recommend that you contact your primary care provider, a local community-based organization, or your local health department for assistance.


Thank you for your understanding. Please confirm if you would like to continue with the PrEP application process.


Please Read Carefully

Important! A recent HIV negative result is required for your initial appointment, and it must be no more than 10 days old.

The entire process will take about 10 min to successfully fill out the formulary, please ensure you have the following information ready:


  1. Full Name and Date of Birth (DOB)
  2. Insurance Card information

    If you don’t have insurance, select the option, Im uninsured and one of our technicians will contact you to find the best option available for you.

  3. Home Address

    Specify your current home address or the address where you would like to receive the kit and medication.

Make sure all information is accurate to avoid any delays in processing your request.

Health Assessment

Are you sexually active?

Have you been tested for HIV in the past 3 months?

Are you currently HIV-negative?

Health Assessment

Do you engage in any of the following behaviors? (Check all that apply)

Do you have any of the following medical conditions? (Check all that apply)

Health Assessment

Are you currently taking any medications?

Are you pregnant, planning to become pregnant, or breastfeeding?

Have you had any recent sexually transmitted infections (STIs)?

Would you be willing to do regular follow-up appointments (every 3 months) for ongoing PrEP care?

Gym

As part of our program, we offer a free gym membership. It will remain free and active as long as you are actively receiving your PrEP through our program. If you are interested, which gym would you like to be part of? Please select from the following options:

Basic Information

Address and Shipping Information

Home Address

Shipping Address

Insurance Information

Disclaimer

Please note that a health insurance plan is required for the delivery of medication. If you don’t currently have health insurance, our team will contact you to explore the best options tailored to your needs and provide you with information on suitable health insurance plans.


Please be advised that we will submit a claim to your insurance for the medication prescribed. In the event that out-of-pocket costs arise, we will assist you in enrolling in the drug manufacturer's patient assistance programs to help cover those expenses. However, please note that your insurance will not be billed for the consultation with the doctor or for any required laboratory tests.

Upload your test results (Optional)

Please upload your TEST RESULTS in PDF, JPG or PNG format. If you don’t have your results available at this time, ensure you have them for your initial visit. (This is required only for the initial appointment).

You may upload up to 3 files. Allowed formats: PDF, JPG, PNG.