HIV Home Testing Program

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Thank you for your interest in our HIV Home Testing program, and for supporting social distancing.

This testing method is available for individuals 17 years of age and older who meet the following criteria:

Live in Miami-Dade or Broward county
Have NOT tested positive for HIV in the past
Have NOT tested in the last three (3) months
You are NOT a medical patient of Care Resource

Please read the following to understand the home test process completely.

Fill out the request form below as accurately as possible and submit the form. This information is necessary to contact you.
Within 24 – 48 hours, a testing counselor will call you to verify the information provided on the form, and conduct a risk assessment by asking you questions normally asked during routine HIV screenings. This should take approximately 5-10 minutes.
Once the assessment has finished, a method of delivery for an OraQuick home testing kit will be discussed.

Direct Delivery: In most cases, this will be a direct delivery to your doorstep by a testing counselor. You must be home to receive it. The package will have an at-home testing kit and contact information with your counselor’s full name, email address, work phone number and extension, to report the results of your test or have any other questions.

By Mail: In some cases, a test kit can be mailed to your address. This may take up to 3 business days for it to arrive If a test kit is mailed, your counselor’s contact information will be provided to you via email.

Pick Up: Should you prefer to pick up your home testing kit, a testing counselor will advise you of the closest Care Resource health center that has availability. To support social distancing, your kit will be ready for pick up from our outdoor tent and staff.

Testing instructions are located inside the OraQuick packaging. Please follow the directions carefully. The test should be administered as soon as it is received and the results reported to your counselor as soon as possible.

If you are ready to start, fill out the form below and submit your request.

Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City ZIP Code
Date of Birth*
MM slash DD slash YYYY
Country of Birth*
Country
Race*
Ethnicity*
Preferred Language*
When was your last HIV test?*
Have you received a NO-COST HIV test at Care Resource before?
How did you hear about us? (HIV Counselor name if any)
Terms & Conditions:
· I have never tested positive for HIV in the past. I wish to get tested for HIV using a rapid antibody home test kit that will be delivered at no cost to my doorstep. I agree to first speak over the phone with an HIV testing counselor to discuss my risks, provide demographic information, and coordinate the delivery of my test kit.

· Once I receive my at-home test kit, I will follow the directions to do the test accurately. If I need assistance during the testing process, I will contact my testing counselor at the number provided.

· Once I have done the HIV test and determined the result, I will contact my testing counselor to report my results. In the event that it has been over 2 days since my package was delivered, my counselor will call me to follow up. If I get the counselors voicemail, I will leave my name and phone number to be contacted.

· I will report my test result honestly.

· I understand that the information discussed over the phone is confidential.

· A reactive result would require a confirmatory test done in person at a Care Resource location close to me. At that point, additional information and consent forms will be collected by Care Resource.

· Additionally, my local Health Department will contact me to discuss my linkage to HIV medical care, and sex/needle-sharing partners. Voluntary partner services will also be offered to you.

· At any time, I may rescind my participation from the testing process and will contact my Testing Counselor by phone or email.

· I agree to allow Care Resource to contact me regarding any referrals that I am eligible for.

· I have read the Record Use and Release Consent.

· I have read the Client Rights and Responsibilities.
Consent and Accept:*
I accept the terms and conditions.*
Comments
This field is for validation purposes and should be left unchanged.

For media inquiries, please contact Jonathan Welsh, Associate Director of Communications and Development at jwelsh@careresource.org.

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Fill out the request form below as accurately as possible and submit the form. This information is necessary to contact you.

Within 24 – 48 hours, a testing counselor will call you to verify the information provided on the form, and conduct a risk assessment by asking you questions normally asked during routine HIV screenings. This should take approximately 5-10 minutes.

Once the assessment has finished, a method of delivery for an OraQuick home testing kit will be discussed.

By Mail: In some cases, a test kit can be mailed to your address. This may take up to 3 business days for it to arrive If a test kit is mailed, your counselor’s contact information will be provided to you via email.

Pick Up: Should you prefer to pick up your home testing kit, a testing counselor will advise you of the closest Care Resource health center that has availability. To support social distancing, your kit will be ready for pick up from our outdoor tent and staff.

Testing instructions are located inside the OraQuick packaging. Please follow the directions carefully. The test should be administered as soon as it is received and the results reported to your counselor as soon as possible.

· Once I receive my at-home test kit, I will follow the directions to do the test accurately. If I need assistance during the testing process, I will contact my testing counselor at the number provided.

· I will report my test result honestly.

· I understand that the information discussed over the phone is confidential.

· A reactive result would require a confirmatory test done in person at a Care Resource location close to me. At that point, additional information and consent forms will be collected by Care Resource.

· Additionally, my local Health Department will contact me to discuss my linkage to HIV medical care, and sex/needle-sharing partners. Voluntary partner services will also be offered to you.

· At any time, I may rescind my participation from the testing process and will contact my Testing Counselor by phone or email.

· I agree to allow Care Resource to contact me regarding any referrals that I am eligible for.

· I have read the Record Use and Release Consent.

· I have read the Client Rights and Responsibilities.