Get In Touch

Get In Touch!

Hi, I’m Raul and I am here to help, safely and confidentially!

To start, I will need some contact information and the type of service you are requesting.

I will get back to you in 24 to 48 hours.

Fecha / Date

MM slash DD slash YYYY

Name(Required)

Nombre / First Name Apellido / Last Name

Cuidad en La que actualmente vive / Current city of residence(Required)

Servicio Solicitado / Service Requested:(Required)

PrEP VIH / HIV PrEP

Test de VIH / HIV Testing

Test para enfermedades de transmisión sexual / Sexually Transmitted Disease Testing

Tratamiento de VIH / Linkage to HIV Care

He sido expuesto a VIH recientemente / I was recently exposed to HIV

Otro / Other

Método Preferido de Contacto: Preferred Method for the Navigator to contact you back:(Required)

Teléfono / Call

Mensaje de Texto / Text

E-mail

Teléfono / Telephone:(Required)

Hora preferida a la que desea ser contáctado / Preferred time to be contacted

Manana / Morning

Tarde / Afternoon

Noche / After hours

Lenguaje Preferido / Preferred Language:(Required)

English

Español

Português

Français

Other

Email(Required)

Enter Email Confirm Email

Comments(Required)

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