Testing to Go

Testing to Go

NAP offices in Omaha, Lincoln, Kearney and Norfolk are offering Testing to Go. An easy to use HIV self-testing kit will be mailed or you can schedule a pick-up at our Omaha and Lincoln offices at no cost (some conditions do apply). There is no blood needed --- just swab your gum line and results are ready in 20 minutes. Interested? Please complete the form below for a Test to Go. Request are responded to within 24-48 hours (not including weekends or holidays). Please note that we will mail the test kit (in a Plain mailing envelope to the address you provide. If you would rather pick up your test kit, please indicate so below. (Minimum age for Testing to Go is 19)
Name*

First NameLast Name
I would like to receive my test via:*

USPS (mail)Schedule a pick up
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone*

Area CodePhone Number
Email*
example@example.com
Enter your date of birth*

MonthDayYear
Date
best time to contact?*

morningafternoonevening
Per CDC Guidelines we are required to collect demographic information as well as information on sexual activity please complete each section listed below
Race*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Pacific IslanderWhiteNot Specified
Ethnicity*

Hispanic or LatineNot Hispanic or LatineDon't Know
Sex Assigned at Birth*

MaleFemale
Current Gender Identity*

MaleFemaleTransgender male to femaleTransgender female to maleTransgender unspecifiedAnother genderDecline
In the past 5 years have you had a male partner (vaginal/anal/oral)*

YesNo
In the past 5 years have you had a female partner (vaginal/anal/oral)*

YesNo
Do you have any concerns about your ability to administer the self- test kit? ( or your ability to perform the test kit yourself?)*

YesNo
In the past 5 years have you had a Transgender partner (vaginal/anal/oral)*

YesNo
In the past 5 years have you injected drugs or substances*

YesNo
Do you understand that you will need to report your test results back to NAP upon completion and that a member of our staff will be reaching out to you for a follow-up if we have not heard from you within a week?*

YesNo
Do you understand that HIV tests are completely confidential and that your information is protected and will not be shared with anyone without written permission,except to the Health Department if the result of your test kit is a preliminary reactive in efforts to help you get the care that you would need.*

YesNo
By clicking this check box, I acknowledge that I have provided a phone number and email address above. I also authorize the NAP staff to contact me regarding my request.*

I Acknowledge
I understand the information I have provided is completely confidential and will not be shared with anyone outside of a preliminary reactive result. By signing, I acknowledge the information provided is true to the best of my knowledge and I agree to have NAP staff contact me to discuss next steps for my participation in the self testing program. *

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