Test - Johns Hopkins-CIDNI

"*" indicates required fields

Step 1 of 7

Are you a patient or community health worker ?*

PatientI am a patient seeking assistance.

Health WorkerI am a community health worker seeking to assist a patient.

I want health services for:

select all that apply

PrEP

HIV

Hepatitis

STI

Substance Use & Prevention

I am not sure

I need free testing for:

select all that apply
If you’re not sure which of these you need testing for, please click the info button beside them to learn more.

HIV We offer rapid testing options in office or in the community. X More Info Learn More

Hepatitis C This test is only available at our office or at a community event. We are happy to schedule this test for you. X More Info Learn More

STI We send swabs for you to collect and mail back to us. We then provide counseling with your results. X More Info Learn More

I am not sure

I want to be tested at:

CIDNI Office 511 N Washington Street, Baltimore, MD 21205

My Home Receive testing kit in mail

Mobile Van Receive testing in our mobile van or a local participating pharmacy

Is your patient’s HIV viral load detectable or does your patient have social or financial barriers to care?*

Is Detectable

Unfortunately our funding is unable to assist at this time.

I need assistance for my patient for the following

Check all that apply

I need assistance for my patient for the following

Transportation

Food

Bus Passes

Toiletries

Housing Assistance

Clothes

Furniture

Glasses

Prescription Co-pays

Something else

Contact Information

First Name*

Last Name*

Email*

Phone number*

Healthcare Provider or Referral Contact Information

Name*

Clinic or CBO*

Email*

Phone*

"*" indicates required fields

Step 1 of 7

Are you a patient or community health worker ?*

PatientI am a patient seeking assistance.

Health WorkerI am a community health worker seeking to assist a patient.

I want health services for:

select all that apply

PrEP

HIV

Hepatitis

STI

Substance Use & Prevention

I am not sure

I need free testing for:

select all that apply
If you’re not sure which of these you need testing for, please click the info button beside them to learn more.

HIV We offer rapid testing options in office or in the community. X More Info Learn More

Hepatitis C This test is only available at our office or at a community event. We are happy to schedule this test for you. X More Info Learn More

STI We send swabs for you to collect and mail back to us. We then provide counseling with your results. X More Info Learn More

I am not sure

I want to be tested at:

CIDNI Office 511 N Washington Street, Baltimore, MD 21205

My Home Receive testing kit in mail

Mobile Van Receive testing in our mobile van or a local participating pharmacy

Is your patient’s HIV viral load detectable or does your patient have social or financial barriers to care?*

Is Detectable

Unfortunately our funding is unable to assist at this time.

I need assistance for my patient for the following

Check all that apply

I need assistance for my patient for the following

Transportation

Food

Bus Passes

Toiletries

Housing Assistance

Clothes

Furniture

Glasses

Prescription Co-pays

Something else

Contact Information

First Name*

Last Name*

Email*

Phone number*

Healthcare Provider or Referral Contact Information

Name*

Clinic or CBO*

Email*

Phone*

443-326-5759

Unfortunately our funding is unable to assist at this time.

I need assistance for my patient for the following

Contact Information

Healthcare Provider or Referral Contact Information

Unfortunately our funding is unable to assist at this time.

I need assistance for my patient for the following

Contact Information

Healthcare Provider or Referral Contact Information