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.
Email address *
Name (first and last) *
Mailing Address (street) *
Mailing Address (City, State, ZIP) *
Gender *
Required
What is your age? *
Required
Do you identify as Hispanic, Latinx, or Spanish? *
Required
How long has it been since your last HIV test? *
Required
What is your race? For mixed race, select all that apply. *
Required
What best describes your sexual orientation? (select one) *
Required
Which best describes your use of Pre-Exposure Prophylaxis (PrEP)? To learn more about PrEP, check out https://getpreptn.com/ *
Required
What might have put you at risk for HIV? (select all that apply)
How would you prefer to receive your At-Home Test Kit? *
Required
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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