Please fill out the questions below.

1. Are you less than or equal 25 years old?
   
   Yes No
2. Have you had either (or both) a new sex partner or multiple partners in the last 90 days?
   
   Yes No
3. Do you have more than one current sex partner at the present time?
   
   Yes No
4. Have you ever been told you had or been treated for a sexually transmitted infection in the past?
   
   Yes No
5. How many sex partners have you had in the last 90 days?
   
   0-1 2-4 5-9 10 or more
6. When you have sex do you use a condom?
   
   Always Sometimes Never