Dried Blood Spot Testing with PEERS Alliance
Please fill out this form to the best of your abilities, not all questions are mandatory, some are completely optional and not required, the data collected from these forms will be completely confidential and only selected staff from PEERS Alliance will have access to this information. 
DBS Testing will only test for HIV, Hepatitis C, and Syphilis. If you're looking for more comprehensive testing, please reach out to your personal physician or the Sexual Health Options, Reproductive Services (SHORS) at 1-844-365-8258
If you have any questions or concerns, please don't hesitate to reach out (e. DBS@peersalliance.ca, p.1-(902)-388-7837)
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Government Name *
Name
Pronouns
Email *
Phone Number *
Emergency Contact (Name & Number)
*Will only contact if we cant get ahold of you, no personal information will be relayed through them *
What would be the preferred way of contacting you? (select all that apply) *
Required
How did you find out about DBS Testing at PEERS Alliance?
Will you be willing to stay for the full 20min appointment? *
Do you have any Allergies we should be aware of? *
Is there anything else you would like us to know prior to your Testing?
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