Request At-Home Services

Trillium Health and the MOCHA Center can send you free, at-home testing kits for HIV and STDs. Request yours today!

**Delivery is for New York State residents only**

If you think you have been exposed to HIV within the last 72 hours, please call the PEP/pharmacy number 585.241.9000.

Contact Information

Name (first and last) *

Date of Birth *

Phone Number (with area code) *

Email *

Best day and time to contact you?

Best way to contact you?

Call

Text

Full Address (please include apt/unit #, city, state, and zip code) *

**PLEASE NOTE: Delivery is for New York State residents only**

How did you hear about our at-home services?

Trillium Health / MOCHA Staff Member (please specify below in "Other")

Other

I want to...

have an at-home HIV test kit mailed to me

have an at-home STD test kit mailed to me

have blood drawn at a lab for syphilis screening

have blood drawn at a lab for Hepatitis C screening

start PrEP to prevent HIV

start PEP because I may have been exposed to HIV within the past 72 hours

discuss insurance options with someone

talk to a doctor about STD symptoms I am experiencing

have condoms and/or lube sent to me

Select your preferred condoms. We will send 10 of each.

Trojan

Lifestyles Ultra Lubricated

Lifestyles Ultra Sensitive

Lifestyles Colors

Magnums

Insertive (for receptive partner)

Latex Variety Pack (we pick for you)

Non-latex

Select your preferred lube. We will send 10 of each.

Silicon

Water-based

Any questions or comments for our team?

Questions/comments