PrEP Registration Form
If you are interested in accessing PrEP, please fill out this form, and as appointments become available, we will notify you. Please note that currently PrEP clinic is on select Wednesdays at 3 - 4:30 p.m. and we will most likely be reaching out to you the Monday before clinic. We will be reaching out to persons on a first come first serve basis in regards to when they fill out this form. Please note that PrEP is $50 per visit, which happens every 3 months or when you need a new prescription. This is for the doctors fee as the medication itself is free. Unfortunately this fee is mandatory but if you need to access PrEP for free, you can do so at the Ladymeade Reference Unit
Sign in to Google to save your progress. Learn more
Name *
Contact Number *
Call or Whatsapp? *
Email (If preferred)
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy