This is the form that we xerox onto the back of the current State of California Risk Assessment Form. It was designed by Nicolas Sheon, counselor at the Berkeley Free Clinic. This is a GIF file which can be pasted into a word processing program such as Word. Just click on the form below and copy and paste. When you print it, the resolution won't be great but you will want to change it anyway, using different referrals, etc. The form takes some getting used to, but once you start using it , you depend on it for infomration going into the disclosure session. For one counselor's comments on the form see Charting on the back of the form.
[ Home ][ Training ][ Advice
][ Research ][ Links
][ Feedback ][ Submit
][About]
[ HIV Prevention Services ][ Berkeley
Free Clinic ][ Confession Box ]