Express Testing Questionnaire - Health Initiative For Men (HIM)

Please answer the following questions required for appointment booking:

Is this your first-time testing or do you have symptoms of an STI, or do you need a vaccine or would like a rapid HIV test? * This question is required. Please answer the question.

Yes No

Has a sex partner informed you that they have an STI or are you concerned about an exposure to HIV in the last 72 hours? * This question is required. Please answer the question.

Yes No

Do you want to book an appointment to start with PrEP or do you have questions for a nurse other than about testing? * This question is required. Please answer the question.

Yes No

Do you have new onset of one or more of the following symptoms: fever, Cough (new or worse than usual), shortness of breath, Diarrhea, Nausea and/or Vomiting, headache, running nose or nasal congestion, sore throat or painful swallowing, loss of appetite or loss of smell, Chills, muscle aches or fatigue * This question is required. Please answer the question.

Yes No

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