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Visiting Our Clinic
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Appointment Information
STI Drop-In Clinic
Clinic Costs
Opening Hours
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Cervical Screening
Contraception
PrEP
STI Testing & Treatment
Unplanned Pregnancy
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Click to expand "Unplanned Pregnancy"
Medical Abortion
Information for Professionals
Down arrow icon
Click to expand "Information for Professionals"
Extended use of LARCs
IUD information for GPs
Progestogen only information for GPs
Contraceptive implant information for GPs
Brochures, Posters & Information Sheets
Counselling
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Click to expand "Counselling"
Counselling Services
Appointment Information and Times
Counselling Costs
Location
Unplanned Pregnancy
Information for Professionals
Helpline
Education
Down arrow icon
Click to expand "Education"
Upcoming Courses
Clinical Education
Down arrow icon
Click to expand "Clinical Education"
Medical Education
Nurse Education
Aboriginal and Torres Strait Islander Scholarship
Clinical Education Refund Policy
Community Education
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Click to expand "Community Education"
Working With Aboriginal People
Working With Young People
Education Sessions For Young People
LGBTI+ Diversity Workplace Training
Regional Training
Tailored Training
Group Visits to SHQ
Events and Forums
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Click to expand "Events and Forums"
National Condom Day 2021
SHARE Forum
Event Requests
Resources
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Health & Service Information
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Condom requests
Request Free Condoms
Fields marked with an * are required
Please note:
Condom donation stock is currently limited. The information provided on this form will be used to determine if your request is eligible for a donation. Priority will be given to target audiences as determined by the SHQ Strategic Plan. Condom requests for demonstration or distribution in schools can only be filled if they are submitted by a staff member (e.g. teacher, nurse).
Name
*
Required
First
Last
Organisation
*
Required
Address
*
Required
Street Address
Address Line 2
City
ZIP / Postal Code
Free resources are only available to organisations based in Western Australia
Email
*
Required
Phone
Title of event (If applicable)
Date of event (if applicable)
- must be mm/dd/yyyy format
Date Format: MM slash DD slash YYYY
Target Audience
Description of service/event
*
Required
Number of participants
Number of condoms required (max quantity 50)
*
Required
Please enter a number from
0
to
50
.
If you are running a larger event or ordering for multiple sites and require more than 50 condoms, please email
[email protected]
and a member of our team will contact you to discuss your request.
Are the Condoms for demonstration purposes* only?
*
Required
Yes
No
*USE OF CONDOMS FOR DEMONSTRATION PURPOSES ONLY SHQ can supply expired condoms (stock permitting) for demonstration purposes i.e. educational demonstrations in showing the correct technique for using condoms. After completing this form, SHQ will require you to sign a condom liability form, no expired condoms can be disseminated until this additional form has been finalised.
Can you collect your order from SHQ in Northbridge?
*
Required
Yes
No
Please note: if you cannot collect, you will be asked to contribute to the cost of postage
Any additional information about your request?
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