• Welcome to the PATH

    Pre-Exposure Prophylaxis Access to Treatment at Home

  • Coastal Family Health Center is excited to offer this online journey to receive your PrEP prevention medication from the comfort of your home.

    The PATH is as easy as one-two-three:

    1. Register with Us
    2. Register for Labs
    3. Meet with Telehealth Providers

  • Format: (000) 000-0000.

  • WELCOME

    POLICY REGARDING THE PROTECTION OF PERSONAL INFORMATION.We create a record of the care and services you receive at Coastal Family Health Center. We need this record in order to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by Coastal Family Health Center, whether made by Center personnel or by your personal doctor. This law requires us to: make sure that medical information that identifies you is kept private; give you this notice of our legal duties and privacy practices with respect to medical information about you; and to follow the terms of notice that are currently in effect. Other ways we may use or disclose your protected healthcare information include: appointment reminders; as required by law; for health related benefits and services; to individuals involved in your care or payment for your care; research; to avert a serious threat to health or safety; and for treatment alternatives. Other uses and disclosures of your personal information could include disclosure to, or for: coroners, medical examiners and funeral directors; health oversight activities; law enforcement; lawsuits and disputes; military and veterans; national security and intelligence activities; organ and tissue donation; and others; public health risks; and worker’s compensation.

  • Patient Information

  • Which sex were you assigned at birth?*
  • What is your gender identity?*
  • What are your preferred pronouns?*
  • Date of Birth*
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  • How do you consider yourself?*
  • What race/ ethnicity do you most closely identify with?*
  • What is your current relationship status?*
  • Have you ever been diagnosed with HIV?*
  • Have you or are you currently taking PrEP?*

  • Health Questionnaire

    Now that we've met, let's continue on the PATH to prevention! Next up is the health questionnaire. Coastal's healthcare providers give top-notch care with truthful answers­. Please answer the following questions as truthfully as possible so that we can make sure PrEP is right for you. Remember: all information provided is confidential and is used to determine the right PATH for you.
  • In the last 72 hours, have you been exposed to the semen or blood of someone you know to be HIV positive?*
  • Who are you normally having sexual intercourse with? Select all that apply.*
  • In the last 6 months, how many sexual partners have you had?*
  • What type of sex do you normally have? Select all that apply.*
  • In the last 6 months, have you had any condomless sex?*
  • In the last 6 months, have any of your sexual partners been HIV positive?*
  • Have you ever been diagnosed with any of these conditions? Select all that apply.*
  • Are you currently taking any medications, herbal treatments like St. John's wort or nutritional supplements such as creatine?*
  • Do you have any drug allergies?*
  • Do you have any questions, or is there anything else we should know?*

  • Insurance

  • Do you have insurance?*

  • We need the following information, or a photo of the front and back of your insurance card. If you like, you can provide this later, but we won't be able to fulfill your prescription without this information. If you have multiple cards (e.g. a separate pharmacy benefit card), be sure to upload a picture of both. We will bill your insurance for the medication, and if necessary, enroll you in one of the drugmakers' patient assistance programs to cover any out-of-pocket costs. Your insurance will not be billed for the doctor consultation or the required labs.
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  • Patient Assistance Program Information

    You're not alone on this PATH to prevention-your Coastal family has team members ready to help enroll you into a patient assistance program that can greatly reduce the cost of PrEP depending on your needs. We just need some financial information!

  • *Please note, in order to qualify for PrEP at no cost, you must not earn more than $62,450 annually. This informationis confidential and is only shared with patient assistance programs and no credit checks are performed.
  • Have you applied for Medicaid?*
  • Are you eligible for VA benefits?*

  • Congratulations!

    Your walk on the PATH to PrEP is almost complete. Now we just need you in for labs!
  • Which appointment time do you prefer?*
  • Where would you like us to fill you prescription?*
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