[DC GOVERNMENT] DOH Condom Distribution Form

DOH Condom Distribution Form

DOH Condom Distribution Form for Businesses

Please be advised that this service is for Washington, DC businesses ONLY.

The DC Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA) encourages the use of latex condoms to prevent HIV and sexually transmitted diseases. District of Columbia organizations and businesses can order condoms and lubricant packages to provide free at locations across the District.

Date Picker

Organization Name

Organization Email

Organization Telephone

Organization Fax

Ward (if known)

Type of Organization

How do you intend to distribute the condoms you receive?

How many regular sized condoms are you requesting? (Quantities of 1,000)

How many large sized condoms are you requesting? (Quantities of 1,000)

How many lubricant packages are you requesting? (Quantities of 1,000)

Do you want to make this a recurring order? If yes please specify:

Condoms and lubricant packages will be shipped directly to your address within 10 business days.

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