Request Our Services

Have any questions?
305-643-7420
Test.Miami@flhealth.gov

Know The Facts
Get Tested
Get Treated
Condoms
HIV Prevention
Providers Corner
Calendar

Know The Facts
Get Tested
Get Treated
Condoms
HIV Prevention
Providers Corner
Calendar

Request Our Services

Community Request Form

Disclaimer: Please allow a minimum of 4 weeks advanced notice for all requests.

Date of Request:

Date of Event:*

Beginning time - End time of event:*

Name of Agency:*

Type of Agency:

Address:

Phone number:*

Email:*

Contact Person:*

Requested Services:

STD/HIV Education (General Population) STD/HIV Testing Educational Session (Indicate Gender) Health Fair (Educational Table) Session for Men Only Session for Women Only

Event Details

Event Description:*

Location of Event:*

Number of people expected:

Please Describe Target Population (by Gender, Race/Ethnicity, Age):

Will there be other service providers at the event ?:*

Yes No

Language:

English Creole Spanish

Materials needed:

Condoms Brochures Other

Restrictions (e.g. no condoms, no sexual content images):

AV Equipment:

Yes No

Site Accommodations (for Testing and Health Fair only)

Room near a Bathroom:

Yes No

Private area for Confidential Screening/Testing:

Yes No

Tents/Tables/Chairs will be provided:

Yes No

Space for Mobile Unit(s):

Yes No

How many Mobile Units requested:

1 2 3 4 5

How did you hear about us?:*

Event Google search Healthcare provider Friend Other

Other, please specify source:*

Comments:

Cancel

Enter ZIP Code to find test
locations & free condoms:

Get in Touch

1350 NW 14th Street, Suite 202B
Miami, FL 33125
305-643-7420
Test.Miami@flhealth.gov
testmiami.org

Site by Frankel Interactive

Request Our Services

Disclaimer: Please allow a minimum of 4 weeks advanced notice for all requests.

Event Details

Site Accommodations (for Testing and Health Fair only)

Enter ZIP Code to find test locations & free condoms:

Quick Links

Get in Touch

Enter ZIP Code to find test
locations & free condoms: