PCAF Prevention Services Request Form
Please fill out the following form to request HIV prevention services through PCAF, including FREE home HIV test kits and/or safer sex materials (e.g., condoms).

Note: By filling out this form you agree to be contacted by a PCAF Prevention staff member. Your HIV test and/or safer sex material request will not be fulfilled until we connect with you via phone and/or e-mail to confirm the shipping address.

If you have any questions, contact prevention@pcaf-wa.org.
Email *
Last Name *
First Name *
Date of Birth *
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Phone Number *
Use Dashes. 253-456-6789
Address: *
City: *
State *
Zip Code *
I am interested in the following PCAF HIV prevention services: *
Required
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