Screen Reader Mode Icon
Privacy Policy: Wellness in Action is a partnership between Arianna's Center and the Human Rights Campaign Foundation (HRCF). Responses will be used only for data analysis and evaluation purposes, and in ways that will not reveal your identity. Your responses will help us to ensure we are meeting the initiatives HIV testing, PrEP and treatment goals and allow us to actively make improvements to the "Wellness in Action" initiative as needed.

Question Title

* 1. Name

Question Title

* 2. Phone number

Question Title

* 3. Race/ethnicity

Question Title

* 4. Sexual Orientation

Question Title

* 5. Gender identity

Question Title

* 6. Age Group

Question Title

* 7. Zip code

Question Title

* 8. How did you hear about the self-testing kit?

Question Title

* 9. If you did not receive a testing kit in person, do you need one shipped to your home?

Question Title

* 10. If you answered yes in the previous question, please provide your shipping address

0 of 10 answered