HIV Testing Supplies Request Form

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HIV Testing Supplies Request

Kansas HIV/AIDS Program

All requests are completed in the order in which they are received. Please allow up to a week for processing.

* Denotes required fields.

* Number of Boxes Requested - Limit is 2 Boxes
  Order includes an assortment of lube, condoms, and red HIV testing bracelets)

Please make a selection.

Questions: Contact (785) 296-4449 or Fax: (785) 296-4197