Order Free Condoms

Please complete the form below

We offer condoms and lube to people living, working or receiving education within the Dudley Borough.

To ensure the safety of our service users, this service is only available to people aged 16 and over. If you’re under the age of 16, please visit Brook Dudley.

Name

First Name

Last Name

Date of Birth

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Address

Address 1

Address 2

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Email

Do you have any special requests?

Please let us know if you need latex free or a condom size which is not regular

Where did you hear about us?