JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Has your life been affected by HIV or hepatitis C?
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Your name:
*
Your answer
Email address
*
(for contact purposes only)
Your answer
Have you or someone you know had a personal experience with HIV, hepatitis C, or another blood-borne illness from intravenous drug use?
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
Forms
This content is neither created nor endorsed by Google.
Report Abuse
Terms of Service
Privacy Policy
Help and feedback
Contact form owner
Help Forms improve
Report