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 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?

Other

I want to...

have someone contact me about testing options that can be mailed to me

discuss options for testing/treatment to address STD symptoms I am experiencing

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

have condoms and/or lube sent to me

Select your preferred condoms. We will send 10 total.

Trojan

Lifestyles Ultra Lubricated

Lifestyles Ultra Sensitive

Lifestyles Colors

Magnums

Insertive (for receptive partner)

Latex Variety Pack (we pick for you)

Select your preferred lube. We will send 10 total.

Silicon

Water-based

Any questions or comments for our team?

Questions/comments

Security Check *