Client Concerns & Essential Support Services for Persons Who Are High-Risk HIV-Negative (PWHRN): Checklist


Please complete this checklist during the client interview. Ask the client to rate each concern on a scale from 1-4.

1=no concern, 2=somewhat concerned, 3= concerned and 4=very concerned.

Feel free to fill this document out online and save it to your computer before printing or to print it and fill it out by hand.


  • Language Access/Translation Services
  • Prevention
  • Pre-Exposure Prophylaxis (PrEP)
  • Non-occupational Post Exposure Prophylaxis (nPEP)
  • STIs and/or Viral Hepatitis (HCV) Services
  • Paying for Healthcare
  • Finding a Provider
  • Housing Assistance
  • Food Assistance
  • Employment Assistance
  • Childcare
  • Transportation
  • Substance Use/Treatment
  • Mental Health Services
  • Intimate Partner Violence (IVA) Assistance
  • Other Concerns

15 pages

Client Concerns & Essential Support Services for PWHRN