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.

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 Thank you!

Other 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 3-4 weeks for this order to be filled.

Male Condoms

Female Condoms

Other Latex Barriers