Confidential Form to Request In-Person STI Testing

Complete the form below to request an appointment for FREE testing for sexually transmitted infections (STIs) at the Clark County Public Health Harm Reduction Center located at 1010 Grand Blvd. Vancouver, WA 98661.

STI testing is available by appointment only:

Days: Tuesdays
Hours: Between 9:00 AM to noon and 1:00 PM to 3:00 PM.
Appointment Length: 30-45 minutes

Testing Offered:

Gonorrhea and Chlamydia
Syphilis
HIV
Hepatitis C

Specimens that may be collected for testing include:

Urine Sample: Self-Collected
Throat, Vaginal, and Rectal Swabs: Self-Collected
Blood Sample: Staff collect from a finger prick and/or blood is drawn from a vein.

We DO NOT perform physical examinations. Our staff may refer you to another clinic for testing and evaluation if you have certain symptoms. This is to ensure you receive appropriate and timely care.

Treatment Offered:

We offer treatment for gonorrhea and chlamydia infections and exposures. There are some situations in which we cannot offer this treatment. If needed, we will connect you with local resources for care.

Partner Testing and Treatment:

Do you need help getting partners tested or treated? Have them fill out a request! We are able to treat partners who have been exposed to an STI.

We understand STI testing can be stressful for some. Our staff strive to provide an inclusive and welcoming environment. If you would like to disclose how you talk about your sexual health (certain terminology, past negative experiences, etc.), please do so in the comments section so our staff can provide client-centered care.

Our services are protected by HIPAA and are confidential. However, all positive/reactive results are required to be reported to the WA State Health Department (DOH) per state law.

Clark County Public Health

STI/HIV Prevention Program

(564) 397-8082 (Confidential Voicemail)

STDProgram@clark.wa.gov (NOT confidential)

First Name (Legal or Nonlegal)*

Last Name*

Preferred Name

Date of Birth*

Assigned Sex at Birth*

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Gender Identity

Pronouns

Race*

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Other* (Please enter race below)

Ethnicity*

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Preferred Language*

Physical Address*

City, State*

Zip Code*

Mailing Address (If different than physical)

Phone Number*

Phone

Is this a home, work, or cell phone number?*

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Email Address*

Do you have health insurance? If yes, what kind?*

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Current Medications? (Enter Name & Dose)*

Allergies and Reaction to Allergies?*

Do you have any of the following symptoms?*

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Other Symptoms (Please describe)*

Have you been exposed to a STI?*

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Other Exposure (Please describe)*

Exposure Date*

Do you have an untreated lab confirmed STI(s)?*

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Other Untreated Lab Confirmed STI

Date Tested for Confirmed STI*

How did you hear about our services?*

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