OraQuick FREE Home Test Kit

Thank you for your interest in the free HIV at home self-testing kit.

The test you’ll receive in the mail is an OraQuick Oral Antibody test; it is performed by placing a swab on the lining of your mouth. Results take 20 minutes to process. Please complete the form and click submit to request your free HIV In-Home, Self-Test Kit.

If you have any questions, please contact Lisset Ivey at the Florida Department of Health in Monroe County (305) 676-3938

Please note: the program is only available to Monroe County residents.

Fields marked with an asterisk (*) are required.

Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

Age *

Country of Birth *

Address Information

Street *

City *

State/Province *

Postal/Zip Code *

Demographics

Please Identify Your Gender? *

Ethnicity *

Race *

Questions

Are you a Monroe County Resident? *

Were you referred to this site by a local organization? *

If yes, please provide name of agency. *

When were you last tested for HIV? *

Enter Confirmation Number

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