STI Test Request - Story

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Referral Candy User Agent

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Please Note: You must be 16 or older to use Stigma Health. You need to be 16 or older to continue.

Personal Details

Hi **, we just need to grab some personal details from you.

Email(Required)

Your PERSONAL email, note we need one email per patient, an email cannot be used multiple times.

Mobile Number(Required)

Your PERSONAL Australian number. Australian numbers only.

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Age

MEDICARE: This form orders a doctors referral for STI testing, with Medicare this is bulk-billed.
NO MEDICARE: This form orders a doctors referral for testing - the pathology companies will still charge you for the tests if you don't have Medicare.
After you complete this order, our referral can be used to claim the cost of testing from your VISA related insurance.

Medicare Card number(Required)

Individual Reference Number (IRN)(Required)

The Individual Reference Number (IRN) is the number in front of your name on your card. Click here to see an example.

Medical History

Thanks **. Routine STI testing is for everyone between relationships or with a social sex life. To determine the tests you need, we need to ask the following questions about your risk factors.

When were you diagnosed with syphilis?(Required)

Estimate is ok. Syphilis infection is likely to show again, with history result is better understood.

When were you diagnosed with HIV?(Required)

Estimate is ok. We won't be testing your HIV. Stigma Health cannot be used to monitor HIV. We refer testing for other STIs.

YOU ONLY COMPLETE TESTING YOU CONSENT TO or WANT.
All tests are referred as per healthcare guidelines, please advise the collector of any exclusions, and that the doctor is aware.

Address

It is a Medicare requirement that we have your Medicare address. Nothing is sent to your address.

Enter 'under21' in the coupon code below to save 20%

Coupon

If you have a referral coupon, enter it here, otherwise continue.

Total

Please specify(Required)

To help us improve STI testing in Australia, please specify.

Comments

This field is for validation purposes and should be left unchanged.

Australia-Wide STI Testing

Personal Details

Medical History

Address