Qualification Survey-At Home HIV Test Kit

Thank you for your interest in the free HIV at home self-testing kit.

The test you’ll receive in the mail is an OraQuick Oral Antibody test; it is performed by placing a swab on the lining of your mouth. Results take 20 minutes to process. Please complete the below details and click the submit button at the end of the form.If you have any questions, please contact the Florida Department of Health in Broward County at 954-847-8132. Please note the program is only available to Broward residents.

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* 1. Are you a Broward County Resident?

Yes

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* 2. Were you referred to this site by a local organization?

Yes