Link-Up Michigan

 

 

 
 

Sign-Up

Are you in need of HIV services? Complete this form and a representative from your local health department will be in touch within a week. 

Name *
Name
Date of Birth *
Date of Birth
Phone Number *
Phone Number
Contact Preference
Call or text? (Note: Caller will not identify HIV status. Caller will say they are "calling from the local health department".
What is the best time to reach you?
What time is best to reach you? (Select all that apply)
Are you HIV positive? *
Are you currently receiving HIV medical care? *