Schedule Your PrEP AppointmentPlease enable JavaScript in your browser to complete this form.Please select a city and location for your appointment: *Chattanooga, TN | Cempa Community Care @ 1000 E 3rd St, Chattanooga, TN 37403Johnson City, TN | ETSU ID Clinic @ 615 N State of Franklin Road, Johnson City, TN 37604New or Returning Client *NewReturningName *FirstLastDate of Birth *SSN *Sex assigned at birth *MaleFemaleGenderSelectAgenderAndrogynousBinaryNon-binaryCis-genderGender non-conformingTransgender MaleTransgender FemaleOtherAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email Address *Preferred form of contactPhone CallText Message Email Do you have insurance?YesNoHave you used PrEP before? YesNoHave you been tested for HIV? *YesNoAre you concerned you may have been exposed to HIV? *YesNoPlease list preferred day(s) and time(s) for an appointment, and we will try to accommodate accordingly. Are you interested in Primary Care services? YesNoNameSubmit COMPASSION. EMPOWERMENT. EXCELLENCE. INTEGRITY. UNITY
