Home-Based HIV Test Giveaway Questionnaire
Welcome! Please answer the following questions to see if you are eligible for a free home-based HIV test. All information collected will be kept confidential. If you have any questions, please email AIDS Resource at firstname.lastname@example.org or call our Williamsport office at 570-322-8448 or our State College office at 814-272-0818.
If you prefer support, then a testing counselor will contact you via email in 1 to 2 business days to schedule a telehealth appointment. Telehealth appointments may be done via phone or video conferencing.
By providing your full name, you give consent to have a free HIV self-testing kit with educational materials mailed to you and that the HIV self-test is for your exclusive use. You agree to hold harmless AIDS Resource, including its staff, directors, and agents, from any and all liability that may arise from self-testing.
You will receive a follow-up questionnaire from email@example.com within 3 days of receipt of the self-testing kit.
If you selected 'Curbside pick up,' you will receive an email from firstname.lastname@example.org within 1 business day to schedule a date and time to pick up your kit.