PrEP Appointment Assessment Request

PrEP (Pre Exposure Prophylaxis) At-Risk Assessment

Truvada, the drug used for PrEP, can be given to individuals who are HIV negative and currently sexually active. Please answer the questions below to see if you qualify for the free or low-cost PrEP program available in the Triangle area.

For a list of NC PrEP providers in your area, please visit the NC ATEC website. You may also contact TEC at 800-806-3558 or email us at This email address is being protected from spambots. You need JavaScript enabled to view it..

A free PrEP At-Risk Assessment is available from us ONLY in the following North Carolina counties: Wake, Orange, and Durham. Unfortunately, we cannot provide this service in other locations.

Are you currently a part of a serodiscordant couple?

Yes

A serodiscordant couple is where one partner is HIV positive and the other is HIV negative.

Are you a male who has sex with other men?

Yes

Have you had unprotected sex in the last 6 months?

Yes

unprotected sex (oral, vaginal, or anal) or experienced a condom breaking/tearing (even if it’s one time)

Have you been diagnosed with any sexually transmitted infections within the last 6 months?

Yes

Do you currently have any health insurance?

Yes

Do you live in the Triangle area?

Yes

Durham, Raleigh or Chapel Hill (Durham, Wake, or Orange counties)

Are you between the ages of 15 and 30?

Yes

Were you born a male?

Yes

Are you of African/Black or Hispanic descent?

Yes

Would you like to be contacted to learn more about PrEP or to set up an appointment?

Yes

What is the best method of contact to reach you?

Phone

What name do you go by?

Email Address

Best Phone