Open bottle of prescription PrEP Pills for Pre-Exposure Prophylaxis to help protect people from HIV.

PrEP Referral Request

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Please use this form to request someone to contact you regarding a free, confidential HIV test and discuss the best option for you.

This service is limited to our 10-county service area (Barrow, Clarke, Elbert, Greene, Jackson, Madison, Morgan, Oconee, Oglethorpe and Walton counties).

A member of our staff will reach out to you via phone or email for the next step.

PrEP Referral Request
Please enter your full name - First and Last
Please be sure to enter a phone number OR an email address in order for us to contact you.
Please be sure to enter a phone number OR an email address in order for us to contact you.
Do you have Health Insurance?
Please be sure to enter a phone number OR an email address in order for us to contact you.
This service is limited to our 10-county service area at this time.
How did you hear about us?
Last Updated on June 15, 2023

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