LGBT Foundation In Person Testing Form

Please complete the fields below to register for our sexual health testing clinic.

This information is used to report to our funders to keep our services free at the point of access. All data is anonymised and helps us to determine who in our communities we are serving.

If testing within this service you agree to being contacted in the following ways:

Phone – from an unknown number or via text
Email
As a last resort, we would write to your address asking you to contact us (but would not put details in the letter of any infections found)

If you have tested with us in the last 12 months, please complete the fields below, including the email you provided last time you tested with us and we will attach it your your existing records. If you wish to change any personal details on our records, including your postal address, please complete the full form by clicking 'No' in the question above.

Street Address

Street Address Line 2

CityCounty

Postal Code

LGBT Foundation now offers a FREE SMS text service that regularly reminds you when you when to book a sexual health test. If you would like a reminder text to be sent to your Phone Number (provided above) please indicate how often below.

Yes - see list of optionsNo - don't sign me upNo - I am already signed up to receive a SMS text

Message me every 3 monthsMessage me every 6 monthsMessage me every 12 months

Please enter a valid phone number.

YesNoPrefer not to say

We ask the next question to help us to meet the needs of all of our service users. We want to make getting support from us as easy as possible. You do not need to have a diagnosis or have been to see a doctor about a disability to tell us how we can help you.

YesNoPrefer not to say

Please complete this form in advance of your sexual health testing. If you do not have enough time in advance of the clinic, we will happily provide you the means to do this when you have your appointment.

If you have had unprotected sex in the last 72 hours, you might benefit from PEP (post-exposure prophylaxis). PEP is an emergency course of medication which can help stop you getting HIV after a potential exposure. You can get PEP from your nearest sexual health clinic, or from an A&E department. To read more visit our PEP page.

Dissatisfied with experience at another service providerAvailability (Time)LGBT Specific ServiceLGBT Environment/Setting

YesNoNot SureRather Not Say

Receptive (Bottom)Penetrative (Top)

All my partner(s) are HIV negativeAll my partner(s) are HIV positiveSome of my partner(s) are HIV positiveI don't know all my partners HIV status, or they haven't had an HIV test

As part of our service offer, we typically provide a questionnaire to help reflect any drug or alcohol related risks. This in turn helps inform our staff on how to to best give advice and signposting should you be interested. All of our staff are trained to discuss any substance use concerns you may have in a non judgemental and supporting way. These questions are optional.

NoYes, but not in the last yearYes, during the last year

NoYes, but not over the last yearYes, over the last year

Domestic abuse is an incident or multiple incidents of controlling, coercive, threatening, degrading or violent behaviour by a partner, ex-partner, or a family member. This can include, but is not limited to: coercive control, psychological, emotional, physical, sexual, financial or economic abuse, harassment and stalking.

Yes - I am concerned I am experiencing domestic abuse and want to talk about itNo - I am NOT concerned I am experiencing domestic abuse or do not want to talk about it

Yes – you have permission to contact me for this purposeNo – you do not have permission to contact me for this purpose

LGBT Foundation - Sexual Health Remote Testing Form

Contact Details

Demographics

Pre Test Questionnaire