TransPonder and HIV Alliance Syringe Delivery Program
TransPonder and HIV Alliance are partnering together to ensure our local transgender population continues to have access to their needed administration supplies for hormone replacement therapy.
This home-delivery supply service will be happening every week. If you are in need of supplies please fill out the form below and we’ll have them delivered.
**Deliveries can only be made within 30 minutes of the Eugene/Springfield area. If you are ouside of that area please fill ou the form with your request and we will email you to find a solution to get you access to supplies.
**Cut-off for same-week delivery is Tuesday @ 5pm. Orders received after Tuesdays at 5 will get bumped to the following week.
**Delivery drivers will only be dropping supplies off, they cannot pickup or take anything away.
(Please provide full address - street/city/zip - so that we can find you) NOTE: DELIVERY DRIVERS CAN ONLY DELIVER WITHIN 30 MINUTES OF EUGENE/SPRINGFIELD!! If you live further out and would like access to this serice, we will email you to strat
Phone Number (This will be used to text you that your supplies are dropped off. Please indicate if you do not have text services and we will call. We will also use this number to contact you if the supplies you want are not available to offer alternative)
Is it ok to identify ourselves when we contact you? (In text we will say "TP", in a call TransPonder)
18g drawing needles
23g 1.5 inch injection needles
25g 1.5 injecting needles
How frequently do you administer your medication?
Once a week
Twice a week
Drop off instructions (any special instructions for how to find you or where to leave the package safely. )
Anything else you you want us to know?
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service