Client Demographic Information

FAITH Enrollment/Testing Form

Fast Affirming Innovative Testing and Healthcare (FAITH) is a sexual wellness and prevention program that centers on transition-related care while normalizing routine health and wellness services for TGNC people across the South. Our services are non-traditional and so is our care. Because our program is led by Trans and Queer people we understand the unique services neccsary to help you feel whole and well not just healthy.

Initial Needs Assessment/Support Services

Please list any services that you need or would like assistance with. (For Membership Only)

	Select
Utility Assistance
Norco Harm Reduction (Overdose Prevention) Kit
Care Packages (deodorant, toothpaste, personal hygiene items, etc.)
Safe Sex Kits (Condoms/Lubricant/education)
Pregnancy Test/Plan B (Day After Pill)
Food Bags/Household Supplies
Counseling/ Mental Health
Housing Stipend

	Select
Counseling/ Support Groups
Name/Gender Marker Amendment (Domestic)
Name/Gender Marker Amendment (Regional)
ID Docs Amendment/Replacement
81 mg Aspirin/Vitamin D, supplements etc.
Medicine Kits (Sharps container, alcohol pads, cotton balls, & band-aids)
Mederma/Scar Cream
Razors/Shaving Cream
Body balm/cream
Hygiene products (deodorant, toothpaste, douche, sanitary pad, etc.)
Cellphone
Food Support


Hormone Therapy (HRT)
Primary Care Physician
STD/STI Testing/Treatment
OB/GYN
None/Not Applicable

Are you considered high risk?

The next set of questions are based on your sexual activity over the last 90 days. Answering these questions helps us better determine if you are at greater risk of contracting HIV.

	Select	Size
Padded Bra
Underwear/Panties
Breast pads, Body Shapers, etc.
Makeup/ Facials/Cosmetics
Lashes/Wigs
Perfume/Body Spray
None

	Select	Size
Underwear/Boxers
Binder/Suppression Suit
Packers/Stp
Shoe lifts (height enhancement)
Minoxidil/beard balm/oil
Cologne/Fragrance
None
Brush, durag, shaving, etc.