Request a home test for chlamydia screening

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Important information

Please note that we can only respond to requests where all information is completed, eg Full address, Date of birth (D.o.B) etc.

Request a home test for chlamydia screening

Screening Request Form

Basic Information
Screening Kit Options
It is important that we provide the right kit for your needs so we would appreciate it if you could answer a couple more questions for us, as honestly as you can.

If you do not see the Submit button it means you've not answered all the questions under Basic Information. Please go back and make sure all of those are filled out first.
If you engage in anal or oral sex you may wish to consider requesting a Throat and / or Anal Swab, please tick the relevant boxes if you would like to do this.

Please note; Where Sex is requested on the form this refers to the sex you were assigned at birth. eg If you were born 'male' then regardless of Gender Identity you would click on the 'male' option, and if you were born 'female' then you would click the 'female' option.

Broad Street Plaza, Calderdale : 01422 261370
Huddersfield Royal Infirmary (HIV clinic) : 01484 347077