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Junk Mail Order Form
Please use this form to order contraceptives.  Orders will be mailed out at least once per week.  We cannot guarantee pickup or delivery any sooner.  Items, with the exception of Emergency Contraception, are also available in the Penfield 24 hour room Health Hub vending machine (free), Health Services (free), SHOP (both the main campus and Syracuse campuses), and in many residence halls.

Emergency contraception is in the Health Hub Vending Machine in the Laker Lounge in Marano Campus Center.  It is $10 (credit card only).  If you need Plan B faster, please use this option, as we cannot guarantee fast delivery or pickup.

Plan B is also available at Health Services during normal business hours.  The cost is $10.

If you or your partner have a latex allergy, please note that under comments.

Email *
What is your first and last name? *
Where do you live? *
What is your room number? *
How would you like to pick up your supplies? *
Select which products you would like (quantities of 5).  You may only choose 3 types per order.  If more than three are chosen, you will receive the first 3 checked: *
Required
Please note: If you order Plan B--the items will be delivered to your residence hall within a week.  If you need it sooner, please comment below and we will hold it in 501 Culkin for discreet pickup during business hours (M-F from 8:30am-4pm). No weekend, holiday, or after hours pickup is available.
Is this your first delivery order? *
Comments
A copy of your responses will be emailed to .
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