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Fill out this form to receive free condoms in the mail

Policy Confirmation: You are only allowed to get ONE package per person per month. We will send out a duplicate order if you have a roommate that needs additional condoms just make sure they fill out this form under there own name.  

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Josh Shapiro, Governor

Debra L. Bogen, Secretary of Health

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This project is funded, in part, under a contract with the Pennsylvania Department of Health.  Basic data for use in  this study were supplied by the Pennsylvania Department of Health, Harrisburg, Pennsylvania.  The Department specifically disclaims responsibility for any analyses, interpretations or conclusions.

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