New Testing Appointment Request

Testing Appointment Request
Rapid HIV testing is free and confidential at the Pride Center. If you need a same-day testing appointment, please call us at 716.852.7743.

The Pride Center is open for walk-in testing and testing by appointment at the following times:

Mondays, Tuesdays, Thursdays, Fridays: 9am-1pm & 2pm-5pm

Wednesdays: 10am-1pm & 2-6pm
Name *

First NameLast Name
Affirmed/Preferred Name

First NameLast Name
Date of Birth: *

MonthDayYear
Date
My pronouns are:

They/ThemShe/HerHe/HimOther
Have you been tested at the Pride Center before?*

YesNoUnsure
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
What days work best for you?*

MondayTuesdayWednesdayThursdayFridaySaturday
What time works best for you?*

MorningAfternoonEvening
Any specific date/time?

MonthDayYear
Date
Hour Minutes

AM/PM Option
I will need the following accommodations in order to participate:

American Sign Language (ASL) InterpreterWheelchair AccessLarge print formsOther
To confirm or reschedule my appointment, please contact me by: *

EmailPhone CallText Message
If you experience issues submitting this form, please call 716-852-7743 or email your name, pronouns, and phone number to proudones@pridecenterwny.org and someone will be in touch to schedule.
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