Free condoms by post

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Do you need condoms?

We provide a FREE condom postal service to people living in Worcestershire. If you live in Herefordshire, please visit the Sexual Health Services 4 Herefordshire website.

Under 16's - if you are under 16 a member of our Outreach Team will call you for a chat before we process your request. Please make sure you include a mobile or landline telephone number when completing the form. We may call you from a private number so please keep an eye out for our call after submitting a request for condoms.

You have the same rights to confidentiality as an adult. We won't tell your parents/carers or anyone else without your permission. The only time we would tell another professional what you had told us is if we have serious concerns about your safety or welfare. But we will discuss this with you first and give you all the support you need.

Please complete the request form below for condoms via post:

Your Information

Note: Questions marked by * are mandatory

Have you previously attended a Worcestershire Sexual Health Clinic?

Yes
No
Unknown

*This is a mandatory field. First Name:

*This is a mandatory field. Last name:

Previous Names:

Please call me:

*This is a mandatory field. Date of Birth:

Gender at Birth

Male
Female

I Identify as:

My pronouns are:

*This is a mandatory field. Country of birth/origin:

*This is a mandatory field. GP Practice:

*This is a mandatory field. Can we contact your doctor?

Yes
No

*This is a mandatory field. Home address including postcode (please note this is a postal service, contact will be made by post):

*This is a mandatory field. Contact/Phone number:

What is your preferred way for us to contact you? Please tick all that apply

Phone/Mobile
Text
Voicemail

Email Address:

	Yes	No	N/A
We may contact you by email for some feedback. Would this be ok?
*This is a mandatory field. Do you consider yourself to have a disability?

If yes, what type of disability? Please describe/detail here:

*This is a mandatory field. Do you require additional communication support?

Yes
No
N/A

I need:

Communication Support E.g. Hearing Loop, Lip reading,
A Communication Professional E.g. Sign language Interpreter
Information in a specific format E.g. Requires Braille, Information in 20-point sans serif font

Other Assistance: Please Detail:

*This is a mandatory field. Do you or your partner have a latex allergy?

Yes
No

Free condoms by post

Search the Herefordshire and Worcestershire Health and Care NHS Trust website

Do you need condoms?

Please complete the request form below for condoms via post:

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