Know your status! Get tested at home today with our At-Home HIV Test Kits. Please note that we are only able to send the At-Home HIV Test Kits to CT Addresses. Information is confidential and will not be shared. Have you had an HIV test before? *YesNoDon't KnowWithin the last 5 years have you had (check all that apply) *Unprotected vaginal or anal sex with a maleUnprotected vaginal or anal sex with a femaleUnprotected vaginal or anal sex with a transgender individualInjected drugs or substancesHave you ever heard of Pre-Exposure Prophylaxis (PrEP)? (Note: PrEP is a daily pill that can prevent HIV.) *YesNoWhich best describe your use of Pre-Exposure Prophylaxis (PrEP)? *I take PrEP once a day as prescribedI was taking PrEP, but not nowI don't know what PrEP isI have never taken PrEPWhich best describes your sexual orientation? Note: Information is confidential and cannot be shared. *AsexualGayLesbianQuestioningSexually FluidBisexualHeterosexual/StraightPansexualQueerTwo Spirit or Other Native IdentityOtherPlease identify your gender *MaleFemaleTransgender (male to female)Transgender (female to male)GenderQueerNon-BinaryOtherPlease identify your race/ethnicity *Non-Hispanic BlackHispanicNon-Hispanic WhiteAsian/Hawaiian Pacific IslanderAmerican Indian/Alaska NativeMulti-RacialOtherHow did you learn about the free At-Home HIV Test Kit? *GoogleOutreach Worker in bar or at an eventFacebookGrindrScruffJack'dApex WebsiteOther AppOtherDate of Birth *Country of Origin *Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeFirst Name *Last NameWhat are your pronouns? (select all that apply) *He, Him, HisShe, Her, HersThey, Them, TheirsSomething else (indicate below)My pronouns are:Phone Number *May We Text You? *YesNoEmail Address *What is your preferred method of contact? *EmailCallTextWould you be interested in Tele-Testing? This means, we would walk you through the process through video or phone call on a secure network. This allows you to have any questions you may have answered regarding safer sex practices and ways to reduce your risk of contracting HIV and other sexually transmitted infections (STIs). If you are interested in PrEP (Pre-Exposure Prophylaxis), our PrEP Navigator, Jason, can start the referral process with you and answer any questions regarding the start of PrEP. When you check off yes below, we will use the information you've provided us to reach out via email or text so we can set up an appointment with you and send the link or additional information needed to log on with one of our Community Outreach Workers. *YesNoI understand that I need to contact Apex with my results within 10 days of receiving the kit. (You can call us at 203-778-2437 or email us: [email protected]) *I understandI Am Not a Robot *Check BoxSubmit