Free HIV Self-Test Kit Order Form

With the free HIV Self-Test Kit, you can learn your HIV status in just 20 minutes from the comfort and privacy of your own home.

Four reasons to use the HIV Self-Test Kit:

Quick & Easy: Get results in 20 minutes.
Blood Free: A swab of the gums; No needles necessary.
Private: Perform an HIV test when and where you want.
Link to Care: Our team is here to support you.

Free HIV Self-Test Kit Order Form

Name *
Email *
Phone number (to receive delivery update) *
Address 1 *
Address 2
City *
State *
Post Code *
Have you ever used an HIV self-test kit before?

Yes No
May we send you an email survey in the future to ask about your experience with the HIV self-test kit?

Yes No

You can read more information by clicking the buttons below:

HIV self-test Instruction +

Using the HIV Self-Test Kit is as easy as these four steps!

How - To - Video +

Understanding your result +