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KnoWyo Testing Site Update Form
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Email
*
Your email
Name of the organization
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Your answer
Name of the person who is the primary contact for KnoWyo account
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Your answer
Primary email address for KnoWyo account.
This the email address where KnoWyo emails and password resets will go.
*
Your answer
Street address of organization
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Your answer
City
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Your answer
Zip code
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Your answer
Primary phone number of organization
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Your answer
Days and times the organization is open for HIV, STI, and hepatitis B & C testing.
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Your answer
HIV, STI, and hepatitis test scheduling (select all that apply)
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Walk-in
Appointment
Required
Services available at this KnoWyo testing site (select all that apply)
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HIV testing
Chlamydia, gonorrhea, and syphilis testing
Three-site chlamydia and gonorrhea testing
Hepatitis B and C testing
Expedited Partner Therapy (EPT) for STI contacts
Family planning/birth control services
Emergency contraception
Fentanyl Test Strip kits available to the public
Narcan available to the public
Pregnancy testing
Prescriber for Pre-Exposure Prophylaxis (PrEP) or Post-Exposure Prophylaxis (PEP) medication for HIV prevention
LGBTQ+ friendly
Kink/fetish aware STI testing and prevention
Hepatitis A vaccination
Hepatitis B vaccination
HPV vaccination
Maternal Child Health (MCH) services
HIV Case Management
Sliding fee scale
Able to bill Medicaid
Able to bill private insurance
HIV treatment prescriber
Hepatitis C treatment prescriber
Hepatitis C treatment sliding fee scale
Other:
Required
If your organization is able to bill private insurance, what insurance carriers are you able to bill for STI and hepatitis B & C testing? (select all that apply)
United Healthcare
Blue Cross Blue Shield
Cigna
Meritain
Other:
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