Please enable JavaScript in your browser to complete this form.Name *FirstLastAgeEmail *Phone Number *Have you had any recent exposure to HIV?YesNoHave you had a HIV Test done in the last three(3) months? YesNoWhat key population do you identify with *Men Who Have Sex With Men (MSM)Female Sex Workers (FSW)Injecting Drug Users (IDU)TransgenderOthersIf others, please explain*Please note that only eligible candidates will be contacted. Contact will be made in 48 hours. Ineligible applicants can make an appointment for an inhouse facility-based test in any of our facilitiesSubmit
