Get the care you need to Take Control of HIV.Our goal is to connect you to care within 72 hours.Services are inclusive and confidential. Connect with care and support that puts your needs first.What is your preferred name?* First Last What is your email address?* What is your primary number?*Date of Birth Month Day Year Race/Ethnicity* American Indian or Alaskan Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Other What county do you reside?*AdamsBedfordBerksBlairBradfordCameronCarbonCentreClarionClearfieldClintonColumbiaCrawfordCumberlandDauphinElkErieForestFranklinFultonHuntingdonJeffersonJuniataLackawannaLancasterLawrenceLebanonLehighLuzerneLycomingMcKeanMercerMifflinMonroeMontourNorthamptonNorthumberlandPerryPikePotterSchuylkillSnyderSullivanSusquehannaTiogaUnionVenangoWarrenWayneWyomingYorkWe are unable to offer services outside the listed counties.City Please select how we may be of service to you: (select all that apply)* Link to Medical Care Housing Opportunities HIV Testing Support Network Food Assistance PrEP Pep Mental Health (Counseling, Therapy Group) Finding a Doctor Transportation Other What other service may we help you with? HiddenHow did you hear about us? Advertisement (Google, Spotify, Jack’d) Social Media (Facebook, Twitter, Instagram Referral Website Do you use social media? If yes, what platforms do you use? Facebook Instagram Twitter Snapchat TikTok Other What other social media do you use? Preferred method of contact* Email Phone Call Best time to contact you:* Morning Afternoon Evening HiddenTake Control HIV community provides linkage to HIV prevention and care services across Pennsylvania. By completing this form, you are granting permission for the Take Control HIV community to access the information you provide and to contact you. Follow up is typically provided within 72 hours. Acknowledgement* I consent to be contacted.Take Control HIV community provides linkage to HIV prevention and care services across Pennsylvania. By completing this form, you are granting permission for the Take Control HIV community to access the information you provide and to contact you. Follow up is typically provided within 72 hours.CommentsThis field is for validation purposes and should be left unchanged. Live your best HIV life. Download our booklets to learn more about HIV. Learn more
