Detroit Health Department Free Condom Ordering / Ordene condones gratis

Detroit Health Department

Free Condom Ordering /

Ordene condones gratis

Do you live in Detroit, Hamtramck or Highland Park?*

Yes

This service is only for residents of Detroit, Hamtramck and Highland Park.

Solo servimos a los residentes de Detroit, Hamtramck y Highland Park.

First and Last Name / Nombre y Apellido*

E-Mail Address / Correo Electronico

Street Address / Direccion*

Apartment Number / Numero de Apartmento

City / Ciudad*

Detroit

Highland Park

Hamtramck

Zip Code / Codigo postal (zip)*

If your Zip Code is not found below, you're not eligible for this service.

Si su código postal no se encuentra a continuación, no es elegible para este servicio.

Select

Age Group / Grupo de Edad

Younger than 15 / menor que 15

15-19

20-24

25-29

30-39

40+

Condom Type / Variedades de Condones

Latex variety pack / variedades de latex

Latex variety pack plus flavored / Variedades de latex + sabores

Non-latex - latex allergy / Sin latex - alergico a latex

Dental Dams - Dique Dental

FC2™ internal condoms, 2 per order / condones internos, 2 por orden

How Did You Hear About Us? / Como se dio cuenta?

Select

Your personal information will not be shared with any third party. / Su informacion personal no sera compartido con partidos ajenos.

By checking this box, I confirm that I live in Detroit, Highland Park, or Hamtramck. I make this request for myself and agree these condoms are for personal use between consenting individuals and will not be sold. / Al marcar la cajita, confirm que vivo en Detroit, Highland Park o Hamtramck. Hago este pedido por mi mismo y estoy de acuerdo que los condones son pare uso personal entre personas que consienten y no seran vendidos.*

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