Condom Request | BHA For Equality

Condom & Lube Order Service

BHA for Equality is currently providing a free online condom & lube order service which can be accessed via the form below.

Please provide your details and preferences in the form below and we will post condoms and lube to the location provided free of charge. For more information on how to use condoms, click here.

Please note – this service is only available for black and minority ethnic residents of either Leeds or Greater Manchester aged 18 and over due to the nature of our funding and service provision.

Name *

Email *

Contact Number

Postal Address

Postcode *

Age

Gender Identity - Which of the following options best describes how you think of yourself?

Gender Identity (In another way) - please provide details here

Is your gender identity the same as when given at birth?

Sexual Orientation - Which of the following options best describes how you think of yourself?

Sexual Orientation (Other) - please provide details here

Ethnicity - Which of the following options best describes how you think of yourself?

Who do you have sex with?

Do you require large condoms? *

Do you require latex free condoms? *

Any other information?

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Condom & Lube Order Service