Qualtrics Survey | Qualtrics Experience Management

First and last name:

UW email address:

Check the option(s) of safer sex supplies you would like:

Latex, lubricated external (male) condoms (10 count)
Latex, non-lubricated external (male) condom (10 count)
Non-latex, lubricated external (male) condoms (10 count)
Non-latex, silicone-based lubricated internal (female) condoms (5 count)
Single use water-based lubricant packets (10 count)
Specialty condoms (studded condoms, extra strength, etc. based on current inventory) (5 count)

Please allow 5 business days to complete your order, though orders will likely be ready in 1-2 business days. Supplies will be discreetly packaged. Be sure to check expiration dates and for any damage to individual supply packaging before use and do not use supplies if they are expired or damaged.

The Health Promotion Specialist will reach out to you via your UW email address to confirm your order and schedule a time for you to pick up your supplies. The Condom Order Form is not anonymous however order recipient names are private. Contact the Specialist at madieb@uw.edu with questions and concerns.

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