Test @ Home
Getting an HIV test is one of the best first steps you can take to control your health, obtain peace of mind, and help to #EndTheEpidemic in Iowa. The Iowa Department of Public Health and the Project of Primary Health Care are partnering to offer free & rapid HIV tests in the comfort of your own home.

It's simple, easy, confidential and totally free. Fill out this form now to have a free test discreetly mailed to you today! Someone from The Project of Primary Health Care will reach out for a 5-10 minute phone call prior to sending your At-Home Test.

If you have trouble completing this form or would like additional information please contact us by calling 515-248-1595 (ask to speak with Prevention) or by emailing: Dar Krom at dkrom@phcinc.net

If someone has not contacted you within 3 days of filling out this request form please call us directly at: 515-248-1595 and ask to speak with Prevention.

Sign in to Google to save your progress. Learn more
The Project of Primary Health Care is required to do a quick 5-10 minute telephone prescreen prior to sending out your Test Kit. Do you consent to a confidential, non-judgmental pre-screening phone call? *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of State of Iowa.