HIV/STI/PrEP Services Request

WILL COUNTY HEALTH DEPARTMENT & COMMUNITY HEALTH CENTER

Interested in getting more information on HIV/STI Testing and treatment or PrEP?

Fill out the form below and someone from our Care Clinic will follow up with you.

Name(Required)

First Last

Phone(Required)

Enter Email Confirm Email

Preferred Method of Communication(Required)

Phone Call

Text Message

Preferred Language(Required)

English

Spanish

Date of Birth

What Services Are You Requesting?(Required)

(example: HIV or STI testing, PrEP, STI Treatment, HIV+ Services,)

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Phone

This field is for validation purposes and should be left unchanged.