STD Partner Treatment


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DON’T BE SHY.

WE’LL TREAT

THAT STI!

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So, one of our patients informed you that they tested positive for an infection?

Thank you for responsibly reaching out to manage this exposure.

Really, we thank you, and so do all your CURRENT & FUTURE sexual partners, as well as your sexual organs.

For partner treatment, we are happy to reduce the chances of delaying your treatment and possibly infecting others.

There is a $25 fee for our administrative services in managing your information and sending in the prescription.

If you’d like us to provide this service please complete the form below.


Would you like us to proceed with providing you this $25 STD Partner Treatment? *
We will email the invoice to you. via Square, at the email address you list below. Once we’ve received payment, we will send in your treatment.
Name *
Name
Please use name as it appears on ID/Insurance Card.
Cell phone *
Cell phone
Date of birth *
Date of birth
Do you have any drug allergies? *
It is imperative we are informed of any KNOWN drug allergies you have, so we can safely prescribe you the best medication.
Are you currently taking any medications? *
It is imperative we are aware of your medications, so we do not prescribe a medication that will interact with your current medications.
This is necessary in the EMR (electronic medical record) for electronic prescribing.
Do you plan to use your insurance for your prescription? *
We do not need your insurance information, but the pharmacy will at time of pickup.
Privacy Policy *
PRIVACY NOTICE: Information you submit using this form will be emailed to Seattle Women’s & Moms’ Clinic through a HIPAA secure Google platform. It is impossible to assure privacy of any communication by electronic means. If you are uncomfortable with this possible limitation to your privacy, please seek care elsewhere, as our model of care is structured around technology in this capacity. To protect your more sensitive information, we offer a secure patient portal through onpatient. For more information, please read our Notice of Privacy Policies (bottom of page).

If you have exposed additional individuals, we are happy to provide this service to them as well, so you are welcome to provide the clinic information to them.


IMPORTANT INFORMATION:

  • Once you take your medication(s), you MUST abstain from intercourse for SEVEN complete days, otherwise you can expose others and you are not treated.

    • For instance, if your medication is a single dose & you take it on Friday the 10th, you are not safe to have sex and not infect others until the following Saturday (the 18th), 7 complete days later.

  • If you end up having intercourse sooner than 7 days, then you will need to be treated again.

  • If you vomit the medication, you will need to be retreated, so please notify the clinic and we can retreat you.

  • If your sexual partner(s) take(s) the medication a different day than you, for instance 2 days after you, then you will NOT want to have intercourse with sexual partner(s) until they’ve completed their full seven days, otherwise you will be re-infected, EVEN IF you have completed your treatment.