Free Condoms!

Please fill out the below form to request Prevention Supplies.

* Indicates required field

Name *

First

Last

Address - Required if Mailing -- We Will ONLY Mail to Addresses Located in the state of KANSAS *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Choose Delivery Option *

Regular Latex Condoms *

Non-Latex Condoms - PLEASE READ: ONLY ORDER if you ARE ALLERGIC TO LATEX!!! If you Order NON-LATEX condoms, we will NOT send out any other type of condom with your order. *

Extra Large Condoms *

Flavored Condoms - For ORAL SEX ONLY *

Lubricants *

Oral/Dental Dams- We are currently out of stock of Oral/Dental Dams. We will update the site as they become available. *

Female Condoms *

Condom Case - Limit 1 Per Order *

Key Chain *

Please put amounts needed, any comments or special requests below. Large Orders will be referred to our Outreach Department for business and requests for Condom DIspensers. *

Submit

Do you need FREE STI Prevention Supplies? Condoms, Oral/Dental Dams, Lubricants, non-latex condoms? Stop by our office or fill out the form below!**Please note that due to supply and demand, we will ONLY send items to addresses located IN KANSAS**

Please fill out the below form to request Prevention Supplies.

Do you need FREE STI Prevention Supplies? Condoms, Oral/Dental Dams, Lubricants, non-latex condoms? Stop by our office or fill out the form below!

Please note that due to supply and demand, we will ONLY send items to addresses located IN KANSAS