In Home HIV Test Request by Mail - for Idaho residents only
You may also text or call 208-991-4574 ext. 1 to get more information about HIV testing and PrEP referrals.
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Initials (first two letter of first name, first two letter of last name) *
Date of Birth *
Phone number *
This would allow for us to contact you if the package gets returned or to follow up with you regarding results.
Is it ok to leave a message at this number? *
Full Name
This is optional, but it may ensure that the test gets delivered to the address and the correct resident.
Address *
Please include city, state and zip code. Must be an Idaho resident.
Risk assessment
Have you ever been tested for HIV in the past? If so, how long ago?
Clear selection
The result of my most recent HIV test was:
Clear selection
Clear form
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