GetCheckedDC STD and HIV Test Request Form

Request Form
Welcome to the request form for GetCheckedDC. This is a free service administered by the DC Department of Health.

This program provides options for at-home test kits (delivered to the DC address you provide below) and walk-in testing (completed at any Labcorp patient service center in the District, Maryland, and Northern Virginia region).
Please select an option to get started
Please read the following notes prior to completing the request.
- This secure request form should take no longer than five minutes to complete. All survey responses are confidential, and the information you provide is only used to mail your test kit package, contact you about your test results, and improve this public health program.
- This is a mail-based program, which means you must provide your name and mailing address to receive your package.
- All Washington, DC residents 13 and older are eligible for this program. You must enter a Washington, DC zip code in your shipping information to receive your test kit. You may request test kits once every 90 days.
- Please complete the post-test survey. Within two weeks of requesting your STD test kit package, you will receive an email asking you to complete a post-test survey. This survey is important for the continuation of this free program.
- You can also order free condoms from the DC Department of Health. You can place an order online for delivery to your home address.
For any questions related to this program, please email GetCheckedDC@dc.gov.
Welcome to the request form for walk-in testing through GetCheckedDC. This is a free HIV and STD testing service administered by the DC Department of Health. For walk-in testing, DC Health has partnered with Labcorp patient service centers in the District, Maryland, and Northern Virginia region.

Please read the following information before completing this form.

This program is for DC residents, so you must have a DC mailing address to submit this form. If you are a Maryland or Virginia resident, you may receive testing services at the DC Health and Wellness Center instead. To make an appointment, please call 202-741-7692.

This secure request form should take no longer than five minutes to complete. All survey responses are confidential, and the information you provide is only used to send your test order to Labcorp and to evaluate and improve this public health program. Labcorp must have your contact information to process your test order.

After submitting this form, you will receive a confirmation email from the DC Health and Wellness Center that includes your order information. Please wait until you receive the email before proceeding. It should arrive in one or two business days.

After receiving the confirmation email, you can go to any Labcorp patient service center in the District, Maryland, and Northern Virgina region for testing. Click here to find the nearest center and make an appointment. Walk-ins are welcome at Labcorp, but you can make an appointment to avoid waiting. Same-day appointments are often available.

You will receive your test results through the DC Health & Wellness Center patient portal in about a week. Please check your email for instructions on how to create an account.
- You can request only the at-home HIV test kit, only the at-home STD test kit, or both at-home test kits. If you request both test kits, please note that they will be mailed separately and will arrive separately.
  
  At-home HIV test kits are mailed directly from Together TakeMeHome, whereas at-home STD test kits are mailed from Molecular Testing Labs.
- Which at-home test kit(s) are you requesting? (Select all that apply.)
- HIV Test Kit
  
  Please visit Together TakeMeHome to request an at-home HIV test kit. If you also request an at-home STD test kit please complete and submit the form below.
- STD Test Kit Type
- Which walk-in tests are you requesting?
- When do you think you will go to Labcorp to receive your testing?
- What is your Date of Birth?
  
  MonthDayYear
- Name
  
  First NameLast Name
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Mailing Address (P.O boxes not accepted)
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- City
- State
- What is your current gender identity?
  
  Other
- What is your sex at birth?
- What is your ethnicity?
- What is your race? (Select all that apply)
  
  Other
- What is your health insurance status
- The following questions are asked to collect program usage data, which helps inform our HIV and STD prevention, treatment and care programs at the DC Department of Health.
  
  This information will not be used for any other purposes.
- What was the gender of your sexual partners in the last 12 months? (check any that apply)
- How do you meet your sexual partners?
- How long ago was your last HIV test?
- How long ago was your last STD test?
- Has a medical professional ever told you that you have any of the following conditions?
- Have you ever heard of PrEP, or pre-exposure prophylaxis, for HIV prevention?
- Are any of the following statements about PrEP true for you?
- addressverification
- Would you like to talk to a DC Health medical provider about starting PrEP? (Please note that PrEP can be accessed for free within DC or neighboring states.)
- Why are you using GetCheckedDC for your testing services? (check all that apply)
- How did you hear about the GetCheckedDC Program?
  
  Other
- By submitting a request form, you are agreeing to the GetCheckedDC data use terms. Information submitted in GetCheckedDC request forms and feedback surveys will be collected in Jotform, which is a database compliant with the Health Insurance Portability and Accountability Act of 1996. All web-based data transmissions are encrypted, and user access is restricted on a role-specific basis. GetCheckedDC will retain and share certain data elements for program research and development but will not share personally identifiable information (e.g., name, email address, mailing address). If you have any questions or concerns, send an email to GetCheckedDC@dc.gov
- Please verify that you are human
- ordered_date
  
  MonthDayYear
  Hour MinutesAM/PM Option
- Should be Empty:

Request Form

You can request only the at-home HIV test kit, only the at-home STD test kit, or both at-home test kits. If you request both test kits, please note that they will be mailed separately and will arrive separately.

The following questions are asked to collect program usage data, which helps inform our HIV and STD prevention, treatment and care programs at the DC Department of Health.