Post-Test Survey

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

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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.  

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*Indicates required field

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WHAT IS YOUR UNIQUE ID? *

WHAT WAS THE RESULT OF YOUR TEST? *

Negative

Preliminary Positive

Invalid/Inconclusive

EMAIL *

PHONE NUMBER *

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