Test kit triage with U18 C Do you live in West Sussex?*SelectYesNoSorry - you are not eligible for online testing because you live outside our service area. Click here to find out more about our services, or call us on 01903 285199Date of birth:* Day Month Year Tell us your gender:*SelectMaleFemaleTransYour answer indicates that you need a telephone consultation - please call 01903 285199 to book.Who do you have sex with?*SelectI only have sex with menI only have sex with womenI have sex with both men and womenYour answer indicates that you should have a quick chat with a member of the team to discuss whether you need to attend a clinic. Please call us on 01903 285199 to arrange a good time to talk. Your answer indicates that you should have a quick chat with a member of the team to discuss whether you need to attend a clinic. Please call us on 01903 285199 to arrange a good time to talk. Do you have any of the following symptoms of a Sexually Transmitted Infection?* A discharge from your genitals (penis, anus) A rash or spots around your penis Lumps or bumps in or around your genitals Pain when you pass urine Any sores or ulcers in or around your gentials Any other symptoms or concerns None of the above Your answer indicates that you should have a quick chat with a member of the team to discuss whether you need to attend a clinic. Please call us on 01903 285199 to arrange a good time to talk. Do you have any of the following symptoms of a Sexually Transmitted Infection?* A change in your usual vaginal discharge Bleeding between your periods or after sex Pain with sex Lumps or bumps in or around your genitals Pain when you pass urine Any sores or ulcers in or around your gentials Any other symptoms or concerns None of the above Do you have any of the following symptoms of a Sexually Transmitted Infection?* A change in your usual vaginal discharge Bleeding between your periods or after sex Pain with sex Lumps or bumps in or around your genitals Pain when you pass urine Any sores or ulcers in or around your gentials Any other symptoms or concerns None of the above Do you have any of the following symptoms of a Sexually Transmitted Infection?* A change in your usual vaginal discharge Bleeding between your periods or after sex Pain with sex Lumps or bumps in or around your genitals Pain when you pass urine Any sores or ulcers in or around your gentials Any other symptoms or concerns None of the above Your answer indicates that you need a telephone consultation - please call 01903 285199 to book.When was the last time you had unprotected penetrative sex? (vaginal, anal or oral sex without a condom)*SelectLess than 2 weeks agoMore than 2 but less than 12 weeks agoMore than 12 weeks agoIf you are testing because you have had sex with someone new or you have a specific concern, please read the following information about window periods (When best to test):Chlamydia and Gonorrhoea may take up to 2 weeks to show up after infectionHIV may take up to 45 days to show up after infectionSyphilis may take up to 12 weeks to show up after infectionWe recommend testing after the window period, but if you feel unable to wait, please remember to repeat tests at a later date if concerned.Take control of your sexual health and check yourself routinely - We recommend testing at least yearlyUsing condoms for sex will reduce the risks of catching and passing on STIs . You can access free condoms within our clinics or by joining the C Card Scheme If you are testing because you have had sex with someone new or you have a specific concern, please read the following information about window periods (When best to test):Chlamydia and Gonorrhoea may take up to 2 weeks to show up after infectionHIV may take up to 45 days to show up after infectionSyphilis may take up to 12 weeks to show up after infectionWe recommend testing after the window period, but if you feel unable to wait, please remember to repeat tests at a later date if concerned.Take control of your sexual health and check yourself routinely - We recommend testing at least yearlyUsing condoms for sex will reduce the risks of catching and passing on STIs . You can access free condoms within our clinics or by joining the C Card Scheme When was the last time you had unprotected penetrative sex? (vaginal, anal or oral sex without a condom)*SelectLess than 5 days agoMore than 5 days but less than 2 weeks agoMore than 2 but less than 12 weeks agoMore than 12 weeks agoIf you are not using any other form of contraception you may be at risk of pregnancy. Emergency contraception can be used to reduce the risk of unwanted pregnancy. If the unprotected sex was up to 120 hours ago (5 days), you can access emergency contraception pills from community pharmacy, your GP or sexual health services, or you could have an IUD (coil) fitted in sexual health services and some GPs. To discuss emergency contraception from Sexual Health West Sussex you can book an appointment Click here for more information or phone 01903 285199. If you are testing because you have had sex with someone new or you have a specific concern, please read the following information about window periods (When best to test):Chlamydia and Gonorrhoea may take up to 2 weeks to show up after infectionHIV may take up to 45 days to show up after infectionSyphilis may take up to 12 weeks to show up after infectionWe recommend testing after the window period, but if you feel unable to wait, please remember to repeat tests at a later date if concerned.Take control of your sexual health and check yourself routinely - We recommend testing at least yearlyUsing condoms for sex will reduce the risks of catching and passing on STIs . You can access free condoms within our clinics or by joining the C Card Scheme If you are testing because you have had sex with someone new or you have a specific concern, please read the following information about window periods (When best to test):Chlamydia and Gonorrhoea may take up to 2 weeks to show up after infectionHIV may take up to 45 days to show up after infectionSyphilis may take up to 12 weeks to show up after infectionWe recommend testing after the window period, but if you feel unable to wait, please remember to repeat tests at a later date if concerned.Take control of your sexual health and check yourself routinely - We recommend testing at least yearlyUsing condoms for sex will reduce the risks of catching and passing on STIs . You can access free condoms within our clinics or by joining the C Card Scheme If you are testing because you have had sex with someone new or you have a specific concern, please read the following information about window periods (When best to test):Chlamydia and Gonorrhoea may take up to 2 weeks to show up after infectionHIV may take up to 45 days to show up after infectionSyphilis may take up to 12 weeks to show up after infectionWe recommend testing after the window period, but if you feel unable to wait, please remember to repeat tests at a later date if concerned.Take control of your sexual health and check yourself routinely - We recommend testing at least yearlyUsing condoms for sex will reduce the risks of catching and passing on STIs . You can access free condoms within our clinics or by joining the C Card Scheme Have you had sex with someone who you know to have had a Sexually Transmitted Infection in the last 3 months, not including genital herpes or warts?*SelectYesNoYour answer indicates that you should have a quick chat with a member of the team to discuss whether you need to attend a clinic. Please call us on 01903 285199 to arrange a good time to talk. Since your last sexual health check-up have you had unprotected sex with someone who is NOT from the UK or Western Europe?*SelectYesNoYour answer indicates that you should have a quick chat with a member of the team to discuss whether you need to attend a clinic. Please call us on 01903 285199 to arrange a good time to talk. Since your last sexual health check-up have you injected drugs or had sex with someone who injects drugs?*SelectYesNoYour answer indicates that you should have a quick chat with a member of the team to discuss whether you need to attend a clinic. Please call us on 01903 285199 to arrange a good time to talk. Since your last sexual health check-up, have you ever been paid for sex or received money, drink or drugs in exchange for sex?*SelectYesNoYour answer indicates that you should have a quick chat with a member of the team to discuss whether you need to attend a clinic. Please call us on 01903 285199 to arrange a good time to talk. Since your last sexual health check-up, have you had sex with someone who you knew was HIV positive?*SelectYesNoYour answer indicates that you should have a quick chat with a member of the team to discuss whether you need to attend a clinic. Please call us on 01903 285199 to arrange a good time to talk. Since your last check-up has your partner has sex with men?*SelectYesNoYour answer indicates that you should have a quick chat with a member of the team to discuss whether you need to attend a clinic. Please call us on 01903 285199 to arrange a good time to talk. Are any of your sexual partners more than 4 years older or younger than you, or in a position of trust (e.g teacher, police officer, youth worker)?*SelectYesNoHas someone you’ve had sex with physically hurt you, made you feel scared or controlled you?*SelectYesNoHave you felt unable to say no to sex?*SelectYesNoHas anyone ever given you gifts, money, drugs, alcohol or protection for sex?*SelectYesNoDo you ever take drugs or drink alcohol before having sex?*SelectYesNoHave you ever been involved in sending or receiving messages of a sexual nature, or does someone have sexual pictures of you?*SelectYesNoHave you ever gone missing from home or care?*SelectYesNoHave you tried to hurt yourself or self-harm?*SelectYesNoAre you involved with any other agencies or professionals (e.g. social worker or mental health team)?*SelectYesNoFrom your responses it looks like you are able to access the STI test kit online - please provide the following details to receive one through the post:From your responses it looks like you are able to access the STI test kit online - please provide the following details to receive one through the post:Your first name:* Your surname: Your full address:*Postcode:* Your mobile number:*Please provide a mobile number to receive reminders and results by text. We will not use your personal details for any other purpose or share them with any other organisation. Your first name:* Your surname:* Your full address:*Postcode:* Your mobile number:*Please provide a mobile number to receive reminders and results by text. We will not use your personal details for any other purpose or share them with any other organisation. Your ethnic origin:All demographic information submitted is held confidentially and for statistical purposes onlySelectWhite BritishWhite IrishAny other White backgroundCaribbeanAfricanAny other Black backgroundChineseIndianPakistaniBangladeshiAny other Asian backgroundWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other mixed backgroundI do not wish to answer this questionYour country of birth: Your ethnic origin:All demographic information submitted is held confidentially and for statistical purposes onlySelectWhite BritishWhite IrishAny other White backgroundCaribbeanAfricanAny other Black backgroundChineseIndianPakistaniBangladeshiAny other Asian backgroundWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other mixed backgroundI do not wish to answer this questionYour country of birth: How did you hear about online testing?SelectOur websiteSocial mediaGoogle/other search engineWord of mouthOther NHS serviceEvent at school/college/universityPoster/other advertisementOtherHow did you hear about online testing?SelectOur websiteSocial mediaGoogle/other search engineWord of mouthOther NHS serviceEvent at school/college/universityPoster/other advertisementOtherHiddenHide button
