Online Inquiry - HCV Inquiry

Hepatitis C Inquiry
Your Information

Please complete the following to receive more information about Hepatitis C from an ARcare team member. Your information is strictly kept confidential.
IMPORTANT: If you are currently experiencing a medical emergency or think you were exposed to HIV within the last 72 hours, please seek immediate care at your local emergency room or urgent care facility.
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Your Name (First and Last)*
Date of Birth*

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Preferred Method of Contact*

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Your Email Address*
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Phone Number*
Would you like to receive information about HIV, Hepatitis C, and sexually transmitted disease (STD) prevention, testing, and treatment?*

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Would you like to receive information about other ARcare services, including primary care, behavioral health, pharmacies, etc.?*

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How did you hear about us?*

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By signing below, I give my consent to be contacted by an ARcare team member to provide me with the information I am requesting.
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Hepatitis C Inquiry