Detroit Health Department HIV/STD Bulk Partner Orders

Detroit Health Department

HIV/STD Bulk Partner Orders

The City of Detroit provides Non-Profit Organizations serving City of Detroit, Hamtramck, and Highland Park residents with a free supply of condoms, which can be picked up at our 100 Mack Avenue location or can be delivered to your organization. Order as often as you need. Thank you for serving our communities!

Today's Date*

Are you an existing partner?*

If you are unsure, or are not a partner yet - you will be prompted to fill out an application form.

Yes

Unsure

File Upload*

Fill out and upload this form.

Drag and drop files here or

Partner Organization Name*

If your organization name is not listed below, please type it in.

Select or enter value

Organization Contact First and Last Name*

Organization Contact Phone Number*

Phone

Organization Contact Email Address*

Organization Mailing Address*

How many condoms are you requesting?*

100

200

300

500

Would you like to add lubricant foils to your order?*

Yes

How many lubricant foils would you like?*

100

Would you like to add female condoms to your order?*

Yes

How many female condoms would you like?*

Would you like to add dental dams to your order?*

Yes

How many dental dams would you like?*

Order must be picked up from the Detroit Health Department (100 Mack Ave) within 3 days of placing your order.*

Please send any questions/concerns toistayreadydetroit@detroitmi.gov

I acknowledge that I must pick up my order from the Detroit Health Department (100 Mack Ave).

Send me a copy of my responses

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