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SHELL HEALTH

HIV & STI
Testing
Registration

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Complete the form below to register for HIV & STI Testing at AIDS Alabama South.​

If you are here for a PrEP Follow-Up, use the Clinic Registration Form, and select that option.

DO NOT SUBMIT THIS FORM UNLESS YOU ARE IN THE LOBBY.

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Gender Identity (Choose all that apply)
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Housing Status:
Have you had a previous HIV test with AIDS Alabama South?
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Have you been tested for STIs/STDs in the last 24 months?
If yes, which ones
Have you been treated for STIs/STDs in the last 24 months?
If yes, which ones
On a scale of 1 - 10 (with 10 being always, and 1 being never), how often do you use condoms?
In the last 12 months, have you had VAGINAL sex?
In the last 12 months, have you had ANAL sex?
In the last 12 months, have you had ORAL sex?
In the last 12 months, have you had sex with a MALE?
In the last 12 months, have you had sex with a FEMALE?
In the last 12 months, have you had with someone who is TRANSGENDER?
In the last 12 months, have you had sex with MULTIPLE PARTNERS?
In the last 12 months, have you had MAN who has sex with MEN?
In the last 12 months, have you had sex with someone who is living with HIV?
In the last 12 months, have you had sex with someone who uses INJECTION DRUGS?
In the last 12 months, have you had sex with someone who had an STI?
In the last 12 months, have you had sex with someone while INTOXICATED OR HIGH?
In the last 12 months, have you had sex with someone who has HEMOPHILIA, or has had a TRANSFUSION or TRANSPLANT?
In the last 12 months, have you had sex with someone IN EXCHANGE FOR drugs, money or something you need?
In the last 12 months, have you had sex with SOMEONE WHO EXCHANGES sex for for drugs, money, or something they need?
In the last 12 months, have you had sex with someone of UNKNOWN RISK?