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Home / Pharmacy Health Screener

Pharmacy Health Screener

Name *

First

Last

Date of Birth *

Email *

Phone *

Have you been tested for sexually transmitted infections (STIs/STDs) in the past 12 months? *

Have you been diagnosed with an STI/STD in the past 12 months? *

Are you sexually active? *

Do you use traditional protection such as condoms, dental dams, etc. during sexual activity? *

Do you or your partner(s) have multiple sex partners? *

Have you ever been tested for HIV? *

You said you have been tested for HIV, when was your last test? *

Are you currently taking PrEP (Pre-Exposure Prophylaxis) or PEP (Post-Exposure Prophylaxis) for HIV prevention? *

Are you currently experiencing any of the follow symptoms?

Check all that apply

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