PHYSICIAN-BACKED STD TEST RECOMMENDER

Are you a male or female? Please Select --- Male Female

How old are you? Please Select --- Under 18 18-24 25-29 30-39 40-49 50-59 60-69 70+

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Are your sex partners generally... Please Select --- Male Female Both

Has it been 6+ months since your last STD test OR have you had more than 1 new partner since the last time you tested? Please Select --- Yes No

Are you concerned about your partner(s) sexual activity with others? Please Select --- Yes No

Have you ever used intravenous drugs or had relations with a drug user? Please Select --- Yes No Don't Know

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When was your last STD test? Please Select --- Never +1 Year 6 Months 3 Months

Have you been vaccinated for Hepatitis B? Please Select --- Yes No Don't Know

Have you tested positive for any of the following STDs in the past? Oral Herpes
Genital Herpes
HIV Hepatitis B
Hepatitis C
Syphilis

Would you like to know whether or not you have genital herpes? Please Select --- Yes No

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