Contact-Less Testing Scheduling Request
Where our outreach team comes to you!
This form is used to request confidential, self-administered screening for HIV, Hepatitis C, Gonorrhea, and Chlamydia provided by The Project of the Quad Cities. Please allow 1-2 business days for our outreach team to contact you for scheduling.
I acknowledge that I am 13 years or older *
Required
Preferred Name: *
Phone Number: *
This is so we can call you to schedule.
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