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Clinic REGISTRATION FORM

Clinic Days Are Mondays, Wednesdays, & Fridays

12pm-6pm

Have you tested postive for Covid-19 in the last 14 days?
Have you ever tested for COVID-19?
What is your gender identity?
What is your sexual orientation?
Have you tested for HIV in 2020?
Please choose one or more of the following services:
Are you low-income?

Click here for income guidance

You will be notified by email  or phone of the time and date of your appointment. Thank you.