HIV Testing Location Registration

Information entered into the Center for Black Equity (CBE) database powers our HIV services locator tool. If your organization provides services and you would like to be included in CBE's searchable database, fill out the form below. Please note that required information is marked with an asterisk (*). The form cannot be processed without all the required information.

Organization Details

Question Title

* Address

Name of Point of Contact

Organization

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Website

Email Address

Phone Number

Question Title

* Hours of Operation

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Question Title

* Social Media Sites

Facebook

Twitter

Instagram

Question Title

* Primary Organization Type

Question Title

* Please upload a high res logo

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* Fee Information

Fee

Free Hepatitis B Testing

Free Hepatitis C Testing

Free HIV Testing

Free STD Testing

Insurance Accepted

Medicaid Accepted

No Fee

PrEP for uninsured

Sliding Scale

Question Title

* Support Services

Case Management

Drug Purchasing Assistance, including AIDS Drug Purchasing Assistance (ADAP)

Housing Opportunities for Persons with AIDS/HOPWA

PrEP Navigation

Ryan White Services

Question Title

* Prevention Services

Chlamydia Testing

Gonorrhea Testing

Hepatitis A Testing

Hepatitis B Testing

Hepatitis C Testing

Herpes Testing

Rapid HIV Testing

Syphilis Testing

TB Testing

Question Title

* Does your organization offer self-testing kits?

Yes

Question Title

* Health Care & Treatment

Adult Hepatitis B Vaccine

Family Planning

Hepatitis A Vaccine

Hepatitis B Treatment

Hepatitis C Treatment

HIV/AIDS Medical Treatment

Human Papillomavirus Vaccine

Medication Adherence Education and Counseling

Post-Exposure Prophylaxis (PEP)

Pre-Exposure Prophylaxis (PrEP)

STI Treatment

TB Treatment