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.

Al ingresar mi información aqui, estoy solicitando que Legacy Community Health me contacte para programar una cita y hablar acerca de inscribirme en PrEP o PEP, pruebas de VIH, pruebas de infecciones de transmisión sexual, o pruebas de embarazo.
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Name / Nombre *
Date of Birth / Fecha de nacimiento *
MM
/
DD
/
YYYY
Phone number / Número de teléfono *
Email / Correo electrόnico
Gender (At birth): What sex were you assigned at birth? On your original birth certificate:  - Cuál es el género que le asignaron al nacer (que esta en su certificado de nacimiento)
Current Gender Identity: What is your current gender identity: - Cuál es su identidad de género? *
Required
Which clinic(s) is most convenient? - Cuáles clinicas le quedan más cerca? *
Required
Referral Source
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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