Getting Tested? It’s easy as 1-2-3

Thank you for your interest in Rapid HIV Testing at your location.

Assisted self testing will be made over Zoom at your current location through the location’s computer device, or your phone (if applicable).

You will be in touch with an HIV testing counselor who will walk you through the set up process and administration of the test. Results will be ready in 20 minutes once started. During that time, your counselor will ask demographic and risk factor questions.

Please make sure to submit this consent form prior to testing and to let the front desk/ facilitator at your location that you want to test today.

Once you submit this form, there is a message that will appear that you will show to the person to confirm.

Name*
First Last
Phone*
Email
Where are you doing your Zoom self test?
- Principles Recovery Center
- Jersey College
Terms & Conditions:
· I have never tested positive for HIV in the past. I wish to get tested for HIV using a rapid antibody self-test kit. I agree to having a Zoom session with an HIV testing counselor to discuss my risks, provide demographic information, and direct me how to take the test.

· I will follow the directions to do the test accurately.

· Once 20 minutes have passed since test has initiated, I will report my results honestly and show said result to my HIV testing counselor.

· I understand that the information discussed over Zoom/Phone is confidential.

· A reactive result does not mean I am HIV positive. I will need to go to the nearest Care resource location so that a confirmatory test can be done for me. At the Care Resource location, additional information and consent forms will be collected.

· If it is confirmed that I am HIV positive, 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.

· 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
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