Request for Condom Supplies

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Lansing Area AIDS Network works to provide access to condoms for the Lansing, Michigan area and surrounding communities. If you're from an area outside of the area of coverage, we may contact you to let you know that we are not able to provide you with our services.

We do have condoms distribution hours at our office on Tuesdays from 11am - 3pm, where you can pick up your weekly or monthly supply of condoms. Our office location is 913 W. Holmes Rd, Lansing, MI 48910.

We will not reach out to you unless there is a request for communication or if we cannot mail you condoms. Your information will be kept confidential and will not be shared with any outside agencies.

If you have any questions and concerns, please text or call our Prevention Staff at 517-242-3762.

Name *

Street Address *

City *

State *

Michigan

Zip Code *

Phone Number

What is your preferred method for being contacted? *

Phone Call

Text

Select Condom sizes that you are interested in receiving *

Are you interested in receiving internal condoms, aka female condoms? *

Are you interested in getting tested for HIV? *

Would you like to be contacted to schedule a HIV testing? *

Are you interested in getting PrEP (Pre-exposure Prophylaxis, this is a pill that is taken daily to prevent HIV infections?) *

Would you like to be contacted to learn more about PrEP or to access PrEP? *

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms