HIV/STI Testing Eligibility

Information gathered in this form is only used to determine your testing appointment, is obtained anonymously, and is not retained.

HIV/STI Testing Eligibility Form

What sex were you assigned at birth?(Required)

Male

Female

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Male

What best describes your sexual orientation?(Required)

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Male - Gay, Bisexual, Pansexual, Other

Schedule an HIV/STI testing appointment with one of our skilled nurses. Click the button below.

Book Your HIV/STI Testing Appoinment with CG Public Health

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Male - Straight/Heterosexual or Lesbian

Have you been seen in our clinic before?(Required)

Yes

No or unsure

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Male - Straight/Heterosexual or Lesbian - YES

Are you currently experiencing any of the following symptoms? Please check all that apply.(Required)

Abnormal discharge

Pain with urination

Abdominal pain

Testicular pain

Other

None of the above

Required acknowledgement(Required)

By selecting "none of the above" on the last question I am confirming to the best of my knowledge that I am not pregnant, I do not have STI symptoms, or have been in contact with a confirmed STI. If I develop symptoms the day of my appointment, I understand that I will not be treated with medication that day and will need to schedule an appointment with a nurse.

Agree

Disagree

YOU MUST AGREE TO THE REQUIRED ACKNOWLEDGEMENT TO CONTINUE

Schedule an HIV/STI testing appointment with one of our skilled nurses. Click the button below.

Book Your HIV/STI Testing Appoinment with CG Public Health

Good News! You are eligible for our eXpress Health Clinic. The eXpress Testing Clinic offers full STI testing without a full clinical examination, with limited staff interaction, and self-collection in 30 minutes or less. Schedule your appointment by clicking here, Book Your eXpress Health Clinic Appointment with CG Public Health

If you prefer, you can still schedule a regular appointment with one of our skilled nurses. Click the button below.

Book Your HIV/STI Testing Appoinment with CG Public Health

This field is hidden when viewing the form

Male - Straight/Heterosexual or Lesbian - NO

Are you currently experiencing any of the following symptoms? Please check all that apply.(Required)

Abnormal discharge

Pain with urination

Abdominal pain

Testicular pain

Other

None of the above

Schedule an HIV/STI testing appointment with one of our skilled nurses. Click the button below.

Book Your HIV/STI Testing Appoinment with CG Public Health

This field is hidden when viewing the form

Female

What best describes your sexual orientation?(Required)

This field is hidden when viewing the form

Female - Gay, Bisexual, Pansexual, Other

Are you currently pregnant?(Required)

Yes

Pregnancy acknowledgement(Required)

By selecting "Pregnant" to the question above I acknowledge that I am not eligible for STI testing services. If I choose to schedule an appointment I understand that I will only receive HIV testing services.

Agree

Disagree

YOU MUST AGREE TO THE REQUIRED ACKNOWLEDGEMENT TO CONTINUE

Schedule an HIV/STI testing appointment with one of our skilled nurses. Click the button below.

Book Your HIV/STI Testing Appoinment with CG Public Health

This field is hidden when viewing the form

Female - Straight/Heterosexual or Lesbian

Are you currently pregnant?(Required)

Yes

Pregnancy acknowledgement(Required)

Agree

Disagree

YOU MUST AGREE TO THE REQUIRED ACKNOWLEDGEMENT TO CONTINUE

This field is hidden when viewing the form

Female - Straight/Heterosexual or Lesbian PREGNANT YES

Schedule an HIV/STI testing appointment with one of our skilled nurses. Click the button below.

Book Your HIV/STI Testing Appoinment with CG Public Health

This field is hidden when viewing the form

Female - Straight/Heterosexual or Lesbian PREGNANT NO

Have you been seen in our clinic before?

Yes

No or unsure

This field is hidden when viewing the form

Female - SEEN YES

Are you currently experiencing any of the following symptoms? Please check all that apply.(Required)

Abnormal discharge

Pain with urination

Abdominal pain

Testicular pain

Other

None of the above

Schedule an HIV/STI testing appointment with one of our skilled nurses. Click the button below.

Book Your HIV/STI Testing Appoinment with CG Public Health

Required acknowledgement(Required)

Agree

Disagree

YOU MUST AGREE TO THE REQUIRED ACKNOWLEDGEMENT TO CONTINUE

Good News! You are eligible for our eXpress Health Clinic. The eXpress Testing Clinic offers full STI testing without a full clinical examination, with limited staff interaction, and self-collection in 30 minutes or less. Schedule your appointment by clicking here, Book Your eXpress Health Clinic Appointment with CG Public Health

If you prefer, you can still schedule a regular appointment with one of our skilled nurses. Click the button below.

Book Your HIV/STI Testing Appoinment with CG Public Health

This field is hidden when viewing the form

Female - SEEN NO

Are you currently experiencing any of the following symptoms? Please check all that apply.(Required)

Abnormal discharge

Pain with urination

Abdominal pain

Testicular pain

Other

None of the above

Information gathered in this form is only used to determine your testing appointment, is obtained anonymously, and is not retained.