Barrier Carryout Request form

For those that want a discrete pick-up for barrier methods and sexual health resources, please fill out this form. For more information on types of barrier methods available visit the sexual well-being page. Condoms, dental dams, or lubricants will be placed in a paper bag with your name on it and will be available at the front desk in the Health Promotion and Well-Being Suite in the O’Connor Center. You will receive a confirmation email once your order is filled. Depending on staffing your order date may be changed. Barrier methods can only be requested one week in advance.

Name(Required)
Which barrier methods do you want? (Please pick only two items. You will receive at least two units of each item.)
Which sexual health education materials would you like?
Where would you like to pick up your barrier methods?(Required)