Post-Test Survey

Thank you for choosing the CHIP program for your HIV testing. 

Please fill in the information below. After submitting the finished survey to us, we will send you out a $15 gift card.

 To qualify, you must be living in San Diego County, between the ages of 15-32 years old, and someone who identifies as a man who has sex with men, including trans folks.  

*Indicates required field

 

WHAT IS YOUR UNIQUE ID? *

 

WHAT WAS THE RESULT OF YOUR TEST? *

Negative

Preliminary Positive

Invalid/Inconclusive

 

EMAIL *

 

PHONE NUMBER *

Next Steps

Schedule an Appointment

There are 3 ways to schedule your appointment to see a doctor, choose one to get started

Call Us
800-555-1212
Toll Free
800-555-1212
TTY
(800)735-2922
Email Us
SDPACE@syhealth.org

Schedule an appointment

Fill out the form to get started:

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