VCU Client Registration Appointment Form

Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Client Registration Appointment Form
Testing Location:
CLIENT INFORMATION
Name

First NameMiddle InitialLast NameSuffix
Preferred Name
Birth Date

MonthDayYear
Phone Number
Format: (000) 000-0000.
Would you like information or resources to help prevent pregnancy and/or sexually transmitted infections (STIs)?
V number
Please enter your Student ID number in this box
Email Address

Confirmation Emailexample@example.com

Which STI TESTS ARE RIGHT For YOU?

To ensure the most accurate screening, it is important to select all testing options that match your sexual activities and potential areas of exposure. Many sexually transmitted infections (STIs), including chlamydia and gonorrhea, can be present in specific parts of the body without causing symptoms. Testing only one body site may miss an infection located elsewhere.

Based on your sexual history, you may benefit from testing at one or more of the following sites:

Urine Testing: For genital exposure through vaginal or penile sex.
Vaginal Swab: For individuals with vaginal exposure.
Throat Swab: Recommended if you have engaged in oral sex.
Rectal Swab: Recommended if you have engaged in receptive anal sex.
Blood Testing: Used to screen for HIV, Syphilis, Hepatitis B (HBV), and Hepatitis C (HCV).

Selecting the appropriate testing sites helps ensure that infections are identified and treated promptly, protecting both your health and the health of your partners. If you are unsure which tests to select, a healthcare provider can help determine the most appropriate screening options based on your sexual practices and risk factors.

All information provided is confidential and used solely to support your healthcare needs.
Available Tests: (click all that apply)
Appointment 1
Appointment 2

Please take a photo of your student ID
Should be Empty: