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Use the form below to add or change a non-profit HIV/STD service provider in Texas. Contact us if you have questions.

Change/Add an HIV/STD Service Provider

Name of Organization

Physical Address

City

State

Zip

Mailing Address (if different)

City

State

Zip

Telephone

Fax

Toll Free

TDD/TTY

E-mail

Website

Counties Served

Clientele (General public or limited)

Please select all services your agency provides below:

Please briefly describe any other services offered by your organization which are not listed above:

Name of person submitting form

E-mail address

Thank you for providing us with this information!

Last updated March 29, 2021