Free HIV Testing/Harm Reduction/North Idaho AIDS Coalition

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North
Idaho Alliance of Care

2201 N. Government Way,
Suite E
Coeur d' Alene, ID 83814
(208) 665-1448

About NIAC & Services
Order HIV Self-Test (Idaho)
Order HIV Self-Test (Washington)
Project Filter (Quit Smoking Free)
HOPWA Housing Resources
Mobile Outreach Calendar
Book Online
Contact
Staff
More

Use tab to navigate through the menu items.

This site contains HIV prevention messages that may not be

appropriate for all ages.

HIV Self-Test for Washington.

If you live in Seattle or surrounding area and would like to order a no cost HIV Self-Test, fill out the confidential form below and submit.

HIVST-Seattle and surrounding area

Free HIVST Order Form

First Name

Last Name

Email

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

What is Your Full Birth Date?

What is your age group

18-24

25-34

35-44

45-54

55-64

Which Race/Ethnicity Best Describes You?

American Indian or Alaskan Native?

Asian/Pacific Islander?

Black or African American?

Hispanic?

White/Caucasian?

Multiple Ethnicity/Other?

Do You Think Of Yourself As:

Male

Female

Transgender man/trans man

Transgender woman/ trans woman

Genderqueer/gender

Nonconforming

Other

Prefer not to answer

Do You Think of Yourself As:

Heterosexual?

Homosexual?

Bisexual?

Man who has sex with men?

Prefer not to answer?

Have you Been Tested for HIV Before?

Yes

No

Please Select all That Apply.

One or More Intimate Partners are Living with HIV?

Intravenous Drug User?

Commercial Sex Worker?

Exchange Sex for Something you Need (ex. money, food, housing, drugs).

Other

Prefer not to answer

How did you Hear About us?

Facebook?

Dating Site?

Google?

Friend?

Thanks for your order!

NIAC Nicotine Replac-ement Therapy

Order NRT to be sent to you.

Contact Tobacco Treatment Specalist

Phone Only Program

Link to Website

Phone & Online Program

Link to Website

Online Only Program

Link to Website

Project Filter Quit Line Information

The Quitline is a free program to help you be successful in your quit journey!

The free tobacco cessation program is based on proven strategies that have helped more than 1.5 million people quit tobacco.

NRT Warnings:

Patches: If you are pregnant or breast feeding, only use this medicine on the advice of your health care provider.

Ask your doctor before use if you have heart disease, recent heart attack, irregular heartbeat, high blood pressure, an allergy to adhesive tape or skin problems, stomach ulcers or diabetes, history of seizures, taking prescription medicine for depression or asthma,

Stop using and ask a doctor if skin redness does not go away in four days, irregular heartbeat or palpitations, using a non-nicotine stop smoking drug, symptoms of nicotine overdose (nausea, vomiting, dizziness, diarrhea, weakness and rapid heartbeat, difficulty breathing or rash). Do not use if you are allergic.

Gum: If you are pregnant or breast feeding, only use this medicine on the advice of your health care provider. Ask your doctor before use if you have a sodium-restricted diet, heart disease, recent heart attack, or irregular heartbeat, high blood pressure, stomach ulcers or diabetes, and/or history of seizures, taking a prescription medicine for depression or asthma, using a non-nicotine stop smoking drug.

Stop using and ask a doctor if mouth, teeth, or jaw problems occur, you have irregular heartbeat or palpitations, symptoms of nicotine overdose (nausea, vomiting, dizziness, diarrhea, weakness and rapid heartbeat, difficulty breathing or rash). Do not use if you are allergic.

Lozenges: If you are pregnant or breast feeding, only use this medicine on the advice of your health care provider.

Ask your doctor before use if you have heart disease, recent heart attack, irregular heartbeat, high blood pressure, stomach ulcers or diabetes, history of seizures, taking prescription medicine for depression or asthma, using a non-nicotine stop smoking drug. Stop using and ask a doctor if mouth problems occur, persistent indigestion for server sore throat, irregular heartbeat or palpitations occur, symptoms of nicotine overdose (nausea, vomiting, dizziness, diarrhea, weakness and rapid heartbeat, difficulty breathing or rash). Do not use if you are allergic.

Keep all NRT out of the reach of children and pets.

How to get quit smoking help

There are five ways to get help today (choose one):

(1). Fill out the form below, submit it to NIAC, and we will sign you up and ship you 2-weeks' worth of NRT,

(2). Call our trained staff and Tobacco Treatment Specialists at NIAC and we will walk you through it (208-665-1448),

(3) Do it yourself (DIY) by linking onto the websites above ("Link to Website"),

(4) Call the Quitline (1-800-Quitnow, 24/7 Help),

(5) Attend a free class through our local Public Health District (1-800-926-2588).

Must be 18 years of age or older to receive NRT. Services are only available to Idaho Residence.

I have read an accept terms & conditionsView terms of use

I am 18 years of age or older.

Do you currently smoke or use other forms of tobacco?

Quitting smoking is one of the best things you can do for your health, are you interested in quitting?

Yes

No

Not sure yet

What are some reasons you want to quit tobacco?

How much do you smoke per day?

When do you have your first hit of tobacco?

Have you tried to quit before?

Have you ever tried NRT before in your quit attempts?

If you have used NRT in the past what was your experience?

Do you have questions about which NRT is right for you if any?

NRT Dosing Instructions

Patches

Gum

Gum 2 2.jpg

Lozenges

If you are ready to quit, and you understand the warnings, which NRT product would you like us to ship to you?

What town do you live in?

What is your zipcode?

What county in Idaho do you live in?

What is your date of birth (mm/dd/yyyy)?

What is your perfered language?

English

Spanish

Other

Do you consent to receiving confidential emails from NIAC to check your progress?

Yes

No

Is it ok to leave a voicemail?

Yes

No

Do you require accommodation while particpating in Project Filter programming such as TTY, translator, or relay service?

Yes

No

Disclaimer : We do not provide medical care. Talk to your doctor about your plan to quit tobacco and use of nicotine replacement or other quit smoking medicine if you have any questions or problems.

I have read the disclaimer.

Thank you for submitting

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