Request for HIV Test Forms (Bubble Sheets)
HIV Early Intervention Services (EIS) Program
The Imagine Hope HIV Testing Program has a limited supply of rapid HIV testing supplies.
These are provided to partner agencies at no charge.
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Ascensa / St. Jude's
Brunswick Judicial Circuit Drug Court
CSB of Middle Georgia
CSB of Middle GA - Ogeechee
CSB of Middle GA - Quentin's Place
Coastal Behavioral Health
DeKalb County CSB
DM & ADR
Douglas County CSB
Fulton County Behavioral Health
Georgia Treatment Services
Highland Rivers Health
Highland Rivers/Cobb County CSB
Lanier Treatment Center
Med-Mark Treatment Centers / Chatswort
New Beginnings in Thomasville
New Horizons CSB
New Horizons Nexus
North Fulton Treatment Center
Odyssey Family Counseling Center
Reliance Treatment Center of Statesboro
Ringgold Treatment Center
Unison Behavioral Health
Unison Drug Court
Westcare of Georgia
Is this a New Address?
Number of Part 1 HIV Test Forms (Sheet 1 - Black, Sheet 2, Black & Purple: for ALL testing episodes)
Available in boxes of 100
Number of Part 2 HIV Test Forms (Sheet 3 - Green: for confirmed HIV+ testing episodes)
We recommend that you keep at least 5 on hand
Please allow two weeks for delivery
You will be notified by e-mail when your request can be filled.
A copy of your responses will be emailed to the address you provided.
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