"*" indicates required fields Step 1 of 2 50% Step 1 of 2: Contact InfoLegal Name* First Last Preferred Name* First Last Pronouns*Phone*Email* What option are you interested in? PrEP- daily pill or long acting shot to help prevent HIV before exposure (for people who are HIV negative). nPEP- emergency HIV Prevention after a possible exposure; must start within 72 hours and continue for 28 days. I'm not sure yet Check all that apply.Step 2 of 2: Service InformationAre you insured? Yes No What type of insurance?(Optional - If you have health insurance)Are you currently a patient at the AARC Health Equity Clinic & receiving PrEP Care? Yes No I'm not sure Check all that apply.Are you currently prescribed PrEP medication (daily, injectable, or on-demand)? Yes No I plan to start soon Check all that apply.How did you hear about us? Google Social Media Digital Ad Television Friend Community Event Other Consent I agree to the privacy policy. Δ
