E-Forms Plus

Order STI Test Kit

Complete each form section on the right to order a testkit. Press next to start ordering a test kit.

The form will take approximately: 2 minutes

Personal Information 1/3
First Name

Last Name

Date Of Birth

/

/

If you are under 18,
please contact the main clinic on 0118 322 7202 to discuss options for testing or visit:
safesexberkshire.nhs.uk

By pressing 'next' you agree to having your data submitted securely to The Florey Clinic and to be contacted, if required regarding your order.
Personal Information 2/3
Address Line One

City, town or village

Postcode

Mobile Number
We ask for a phone number incase we need to contact about your order.
Personal Information 3/3
Email

Country Of Birth

Optional

We kindly require this information in order for our service to support you and the community better.

My Ethnic Origin

We kindly require this information in order for our service to support you and the community better.

My Gender Identity
Test-kit Type
Please choose the right kit for you.

I have male genitals

I have female genitals

I have male genitals and I have sex with people who have male genitals

I need a Blood Kit

Optional
So we can make sure we process your samples in the best way, please tick if you have previously been told you have:

HIV

Syphilis
Your order summary

Please review your details above are correct before ordering. 👍

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