logo
logo
  • Home
  • About Us
    • Volunteer
  • BQ+AF
  • STI Self-Testing
  • Programs
    • BQ+: Center for Liberation
    • P.O.W.R Program
    • Transgender Allyship Collective
    • Project Liberate
    • Emergency Funding for Deceased
    • BQ+ Transportation Program
    • BQ+ Employment Program
    • Health Navigation Form
  • News
  • Contact
  • Donate

STI Self-Testing Kit Form

Fill this form out to receive a free self-testing kit which screens for: CHLAMYDIA GONORRHEA HEPATITIS C (Hep C) HIV (I & II) HERPES SIMPLEX 2 SYPHILIS TRICHOMONIASIS (Trich) Our center responds within 24-48 hours. Monday- Saturday
MM slash DD slash YYYY
Name(Required)
Date of Birth(Required)
Valid Address(Required)
What is your gender identity?(Required)

What is your sexual orientation?(Required)

What is your race/ethinicity?(Required)

How did you hear about this testing program?(Required)
Check all that apply.
How often do you get tested?(Required)
Do you know your HIV status?(Required)
Are you familiar with PrEP?(Required)
Employment status(Required)

Living situation (where do you slept most nights in the past 3 months)(Required)
Check all that apply.
This field is for validation purposes and should be left unchanged.

About Us

The Normal Anomaly Initiative, Inc.
10039 Bissonnet Street, Suite 310,
Houston, Texas 77036

Engage With Us

[email protected]
Facebook: The Normal Anomaly Inc.
Instagram: @TheNormalAnomaly
Twitter:@_NormalAnomaly

Links

  • Donate
  • About Us
  • Contact Us

Latest News

  • Black TransWomen Deserve to Grow Old! June 16, 2022
  • LOCAL HOUSTON HIV ADVOCACY ORGANIZATION, THE NORMAL ANOMALY INITIATIVE, TO RECEIVE DONATIONS FROM LIL NAS X “BABY REGISTRY” March 29, 2022
  • Black Queer AF Music Festival Line-Up Announced March 10, 2022

© The Normal Anomaly Initiative | All rights reserved | Designed by Eyenamic Designs

Privacy Preference Center

Privacy Preferences