Free condoms ordering form

Please use the below form to order free condoms from GLiSH.

Full name Required

Date of birth Required

Gender Required

Ethnicity

Country of birth Required

Email address Required

Mobile number Required

Do you have latex allergy Required

What size condoms would you like?

Delivery address Required

Address 1

Address 2

City

Country

County

Postal Code

Please watch the demonstration video

You must answer the following questions if you are under 18 years old.

Your order will not be accepted if you don't answer all of the questions. Please be advised that a clinician may be in contact with you to discuss your answers.

Has anyone ever given you gifts, money, drugs, alcohol, or protection for sex?

Do you feel like you can talk to the person you have sex with about using condoms or other forms of contraception?

Have you ever been made to feel scared or uncomfortable by the person(s) you have been having sexual contact with?

Have you ever been made to do something sexual that you didn’t want to do?

Has anyone ever given you gifts, money, drugs, alcohol, or protection for sex?

Do you often feel down or suffer from feelings of depression?

Have you ever tried to hurt yourself or self-harm?

Is your partner a lot older or younger than you?

I agree to the privacy policy

You must agree before submitting.

Free condoms ordering form