Order Form for Sexual Health Supplies

Fields marked with * are required

You can use your real name, or a fake name, or just initials. We will put the supplies in the pigeon holes, under the first letter of the last name.
Let us know if you would like us to leave the sexual health supplies you've requested at either the Brooks or House 12 pigeon holes or if you'd prefer to collect them from a welfare drop-in session. If you would like to collect them from the drop-ins, you can do this without appointment. See cuths.com/welfare or the Cuth's Welfare Facebook page for our drop-in hours.