Community Mobile Clinic

Bring our Community Mobile Clinic (CMC) to your event! Our CMC offers HIV and STI testing, referrals for PrEP/PEP, and case management services.

Please Note:

Requests should be submitted at least 30 days prior to your event. Events should be a minimum of 4 hours in duration.
Submission of this form does not guarantee the agency's attendance at your event.
Also, when multiple events are requested for the same day, priority is given to LGBTQIA+ events, as they align with our agency's focus on serving this priority population.

Your Agency Name:

Contact Name:

Contact Phone Number:

(###)

###

####

Email:

Date of Event:

Time of Event:

Name of Event:

Address of Event:

Parking Logistics/Specifications:

Detailed Summary of Event:

Estimated number of people attending:

Estimated number of tests: 20

Potential Event Demographic:

Requesting STD Testing?:

Yes

Any additional questions?: