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HIV Testing at the 1917 Clinic
1917 Clinic HIV/STI Testing Appointment Form
Please complete the form below for an HIV/STI testing appointment. All information is confidential. If you have any questions call the Prevention Line (205) 996-4671. Thank you!
Full Name
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Name you like to go by
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Date of Birth
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Telephone Number
(*)
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Have you visited the 1917 Clinic for testing before?
(*)
Yes
No
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Are you interested in receiving a full STI screening during your visit?
(*)
Yes
No
Unsure/Have questions
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Choose an appointment day
(*)
Monday
Tuesday
Wednesday
Thursday
Friday
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Monday Appointment Date(s)
(*)
Monday 10am - 11am
Monday 11am - 12pm
Monday 1pm - 2pm
Monday 2pm - 3pm
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Tuesday Appointment Date(s)
(*)
Tuesday 10am - 11am
Tuesday 11am - 12pm
Tuesday 1pm - 2pm
Tuesday 2pm - 3pm
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Wednesday Appointment Date(s)
(*)
Wednesday 10am - 11am
Wednesday 11am - 12pm
Wednesday 1pm - 2pm
Wednesday 2pm - 3pm
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Thursday Appointment Date(s)
(*)
Thursday 10am - 11am
Thursday 11am - 12pm
Thursday 1pm - 2pm
Thursday 2pm - 3pm
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Friday Appointment Date(s)
(*)
Friday 10am - 11:30am
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Please share any additional information you think will help us take care of you. Your information will remain confidential at all times.
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