About you
We will use this information to inform you of recommended outcomes from your quiz as well as remind you when it’s time for your next appointment or check-up. Find out if you need to do anything for a potential STD next.
First Name
*
Last Name
Email
*
example@example.com
Mobile Phone Number
We will only ever SMS you reminders.
Postcode
*
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Are you experiencing any of the following symptoms?
Severe pelvic pain
*
Yes
No
Do you think you have had a recent high risk sexual exposure?
*
Yes
No
Did your sexual partner use condoms with their previous sexual partners?
*
Yes
No
Has your sexual partner used drugs with needles?
*
Yes
No
Score
recommendationWp
Due for Screening: 10+
No action: 0
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Next
Do you think you may have an STI or STD?
Your information is confidential and not shared - most STDs can be easily treated once identified.
Have you been sexually active?
*
Yes
No
Date of Birth
*
-
Day
-
Month
Year
Gender assigned at birth
*
Male
Female
Todays date
-
Day
-
Month
Year
Age
Last Screening Score
If 1000, they are due for screening. They are of age and haven't done one for 5 years, or have never done one.
dueDate
-
Year
-
Month
Day
Date
Are you experiencing any of the following symptoms?
Ulcers on your genitalia
*
Yes
No
Heavy discharge
*
Yes
No
Kidney pain
*
Yes
No
Submit
Should be Empty: