Refer A Patient

8/23/18 Notice: We are currently experiencing periodic problems processing Refer A Patient forms from select zip codes, and are working to resolve them. If you receive a zip code error when attempting to submit this form, instead please refer your patients as follows:

  • For Exposure Counseling: please call 866-626-6847 (toll-free)
  • For Study Participation (with or without Exposure Counseling): please call 877-311-8972 (toll-free)

We sincerely apologize for the inconvenience, and greatly appreciate your patient referrals!