Condom Ordering Form

Condom Ordering Form

Terms of Use

By placing this order, I agree to each of the following:

  • All items ordered through this program must be provided FREE of charge.
  • All of these items will be distributed solely within Miami-Dade County.
  • The staff, volunteers and other agents of my organization may not knowingly furnish these items for re-distribution outside of Miami-Dade County.
  • I will cooperate with staff from the Florida Department of Health in Miami-Dade County Condom Program in evaluating this program.

Your Contact Information

Do not complete this request form unless a Condom Distribution Application  has already been submitted and you have received authorization to make Condom requests. You must specify below the e-mail address and organization address that was provided on the Condom Application. 

  • *PLEASE NOTE: If the browser you are using is Internet Explorer 10, this form will not work properly. Please use either Google Chrome or Mozilla Firefox.
  • You will receive a confirmation notice from The Florida Department of Health in Miami-Dade Condom Program after placing your request. If you have any further questions regarding this program, please contact Erika Coello at Erika.Coello@flhealth.gov. Thank you!

Shipping Information

Order Requests

Indicate your order on the form below. The quantity specified should be the number of cases you would like for each item.

  • Male Condoms
  • Female Condoms
  • Other Latex Barriers
  • Lubricants

NOTICE: We make no assurances that we have the itemized products in stock. We reserve the right to:

  • Deny any order in whole or in part;
  • Adjust the quantity of orders; and
  • Substitute items.

Please allow approximately 4-6 weeks for this order to be filled.

Male Condoms

Female Condoms

Other Latex Barriers

Lubricants

Cancel

Enter ZIP Code to find test
locations & free condoms: