Request a Callback from Legacy Community Health
By entering my information here I am requesting that the Legacy Community Health contact me about scheduling an appointment to discuss getting on PrEP (Pre-Exposure Prophylaxis) or PEP (Post-Exposure Prophylaxis; after sex), HIV Testing, STI Testing or Pregnancy Testing.
Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Phone number *
Your answer
Email
Your answer
Gender (At birth): What sex were you assigned at birth? On your original birth certificate:
Current Gender Identity: What is your current gender identity: *
Required
Which clinic(s) is most convenient? *
Required
Referral Source
Your answer
For More Information
For more information about Legacy Community Health Pharmacy, PrEP, PEP and other services, please visit our website:
www.LegacyCommunityHealth.org/Pharmacy
www.LegacyCommunityHealth.org/GetTested
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