top of page


In-Home HIV Test Kit Eligibility Form 
*Only Washington State residents will be considered for mail-out tests.  
Please complete form and the SAN program administrator will contact you with more information. 

*This form is private and confidential and only the administrator of this program can access it.

In-Home Testing Request
What is your age group?
What race/ethnicity best describes you?
Gender Identity: Do you think of yourself as:
Sexual Orientation: Do you think of yourself as:
Have you Been Tested for HIV Before?
Please Select all That Apply:

Thanks for submitting!

If you have questions about whether or not you qualify for a free test, please call us at (509) 844-1758 or email.


To request an HIV test at Spokane AIDS Network, please click the button above.

For questions, email or call us at (509) 844-1758.  

bottom of page