HIV Self-Test Kit Order Form
Community Link Distribution Site: AIDS Coalition of Nova Scotia (ACNS)

Welcome! ACNS is pleased to provide free, low barrier, confidential access to HIV self-test kits for anyone living in Nova Scotia, as a Community Link partner. We believe HIV self-testing should be done when you're ready and on your own terms. That's why we want to send you 2 or more free HIV self-test kits via Canada Post; 1 to use now and some to use later or share with your friends or partners!

The questions we're asking you in this order form are optional (there's also a "Prefer not to answer" option), but we collect this information to ship your order and make sure we're reaching everyone who needs HIV self-test kits. Your responses are anonymous (we don't collect names), confidential, and shared only with the Community Link team. For more information about Community Link or this order form, or to schedule a time to pick up your kits at one of our offices, please email communitylinkns@gmail.com.

Let's begin your order!
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Is this your first time testing for HIV?
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What is your age?
Which population do you identify with? (Select all that apply)
What is your current gender identity?
Clear selection
How would you describe your sexuality?
Clear selection
How did you hear about Community Link?
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How many HIV self-test kits would you like sent to you? *
What is your email address?

*We only collect email addresses to contact people if there's a problem with their order (e.g. incorrect shipping address)
Please enter the full mailing address that you would like your HIV self-test kits sent to*

*Include name (optional), the street number, apartment/unit number (if applicable), street name, city name, and postal code
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