STD/STI Screening Request Form

Care Net Pregnancy Center of Southern Maryland offers STI testing free of charge to both men and women.  Our clinic tests for Chlamydia, Gonorrhea, Syphilis and HIV.  Once you have completed this form you will be contacted to schedule your appointment.

Typing your name here gives us permission to call you.
We care about your privacy. Please let us know if we may leave a message on your voicemail or answering machine saying we are calling from Care Net.

Thank you for completing this form.  Our Nurse Manager will contact you about an appointment.