Get Tested
Thank you for your interest in getting an HIV Home test kit from Samaritan Ministry.    

We need to collect some basic information below to make sure you qualify for the free HIV test.

All of your information is kept confidential.  All sections are required.
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Email *
Name (first and last) *
Mailing Address (street) *
Mailing Address (City, State, ZIP) *
Gender *
What is your age? *
Do you identify as Hispanic, Latinx, or Spanish? *
How long has it been since your last HIV test? *
What is your race?  For mixed race, select all that apply. *
What best describes your sexual orientation? (select one) *
Which best describes your use of Pre-Exposure Prophylaxis (PrEP)?                                                                  To learn more about PrEP, check out *
What might have put you vulnerable to getting nor acquiring HIV? (select all that apply)
How would you prefer to receive your At-Home Test Kit? *
How did you learn about Samaritan Ministry's home testing service?
Thank you for completing the Get Tested questionnaire.  We will follow up with a confirmation email.
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