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Local Partners

We partner with local non-profit organizations that can help pay for your medical expenses.

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Personal Info

Sex Assigned at Birth

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Date of birth

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PrEP Conditions

Have you ever been diagnosed with HIV?

Do you already have a current PrEP prescription?

Have you ever been diagnosed with syphilis?

Insurance

Insurance is not needed to participate in this program. But the pharmacy will need to know if Insurance exists.

Do you have insurance?


(Last 4) Social Security #

SSN is used for patient assistance programs, information is not shared with any federal agency. ENTER 1111 IF YOU DO NOT HAVE A SOCIAL SECURITY NUMBER.

Insurance

Thank you for your interest in Q Care Plus. We are committed to servicing all your PrEP needs.

Unfortunately, we have reached our maximum number of uninsured patients at this time, however you may enter to be listed on our waitlist. As soon as we have available spots, our team will contact you directly.

Members from our team and partners may contact you to assist with additional options to access PrEP.

Join Waitlist Confirmation

Thank you for joining the waitlist. As soon as we have available spots, our team will contact you directly.

Gilead Patient Assistance

Lacking Insurance coverage or have been denied coverage by your insurance plan? No problem!

Our team can help by enrolling you into Gilead Advancing Access® or Co-Pay Program, which will likely help cover the cost of your medication. Please note, in order to qualify for PrEP at no cost, you must not earn more than $62,450 annually. This information is confidential and is only shared with the drug maker Gilead and no credit checks are performed. If you make over the amount, we have a few other solutions we can enroll you into to ensure your medications is affordable. The additional information below will help our team do all the work for you!

Number of people in household?

Annual Income

Are you eligibile for Veterans Affairs benefits?

Are you eligibile for Medicaid?

Address

Address

Apartment, suite, floor

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Local Partners

(You are looking at this page again because you changed the zip code you entered at the beginning)

We partner with local non-profit organizations that can help pay for your medical expenses.

(Searching for a local partner...)

Schedule Your Appointment

Schedule your Virtual Appointment with our expert physician. Choose a date and time slot convenient to you from the available slots. We have highlighted dates with open appointment times.

Select Date

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Sign and Submit

Take a look at your info below, feel free to correct anything by using the previous button to return to the correct prompt. To submit your information, click finish.

Name

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Phone

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Date of Birth

Has PrEP?

Is Insured?

Signature

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Thank you for Signing Up!

Look out for an email regarding next steps and your appointment with a Q Care Plus provider. If you did not schedule an appointment we will be in contact or you may contact us at hello@qcareplus.com

We look forward to bringing your PrEP!

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Insurance

 

Due to changes in drug assistance programs, in 2022 it will be important to have insurance to stay on PrEP. “CBO NAME” and Pride Life may be able to get you premium free insurance for 2022. Click the button below to work with Pride Life to see if you are eligible. After entering contact information, Pride Life will contact you to discuss you options

Sign up

 

Not interested

 

Presciption

For my current PrEP prescription, I can:

Health Questionnaire

Have you been exposed to HIV+ blood or semen in the last 72 hours?

Who are you normally having sex with? (check all that apply)

How many sex partners have you had in the last 6 months?

What type of sex do you normally have?(check all that apply)

Have you had sex without a condom in the last 6 months?

Have any of your sex partners been HIV+ in the last 6 months?

Have you been diagnosed with any of the following in the last 6 months?

Have you ever been diagnosed with syphilis?

Have you ever been diagnosed with any of the following? (check all that apply)