Free Condoms Order Form • Te Taenga Mai

Age*

Condoms for under 16s

A quick chat about consent, condoms and keeping yourself safe.

Ethnicity*

Ethnicity (other – please specify)*

Optional: Do you consider yourself to be transgender?

Yes

No

We are collecting gender identity information to be able to evaluate our services and capture the experiences of trans and non-binary people using our offerings. You do not have to answer this question, and it will not affect your eligibility to use this service.

What is your gender identity?*

Gender identity (other – please specify)*

What sexual orientation do you most identify with?*

Sexual orientation (other – please specify)*

What is the gender of your sexual partners?*

Male

Female

Transgender

Non-Binary

Other gender identity

You can select more than one option

Are you or your sexual partners a refugee, migrant, or asylum seeker?*

Yes

No

Your details

Name*

First name Last name

Email*

Email verification*

Password verified.

We’ll send a code to your email address to verify that it’s real.

Which condom size (Male condoms) do you need?*

We will send you 12 male condoms, and lubricant.

Would you like Female (internal) condoms?*

We will send you 2 FC2 pre-lubricated female condoms.

Delivery address

We deliver to New Zealand addresses only. Your free condoms and lube samples will be delivered in a plain envelope.

Delivery address line 1*

Delivery address line 2

Optional, eg. a business name or flat number

Suburb

City*

Postcode*

Free Condoms: Order Form

Order form

Condoms for under 16s

Your details

Delivery address

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