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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
Please put street/PO Box, City, State and Zip Code in boxes below.
Phone Number
*
Email
*
Choose Delivery Option
*
Priority Mail
In Office Pick-Up
Priority Mail with No Return Address
Regular Latex Condoms
*
0
5
6
8
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.
*
0
3
5
6
Extra Large Condoms
*
0
3
5
6
Flavored Condoms - For ORAL SEX ONLY
*
0
3
5
6
Lubricants
*
0
5
6
8
Oral/Dental Dams- We are currently out of stock of Oral/Dental Dams. We will update the site as they become available.
*
0
Female Condoms
*
0
1
2
3
Condom Case - Limit 1 Per Order
*
0
1
Key Chain
*
1
2
3
5
8
10
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
Home
About
HIV Testing
HIV+ Care
Prevention
PrEP Information
>
PrEP FAQ's
PrEP Referral Information
ACA Enrollment
Work With Us!
Volunteer
Board Members
DONATE
Events
Tap Gala
FAQ
Resources
Free Condoms!
Condom Distribution Sites
Distributor Condom Orders