Condom and Lubrication Registration and Order Form
This service is a recognized, established service engaged in an aspect of sexual health promotion within the Republic of Ireland. Sexual Health West is in compliance with HSE National Condom Distribution Service Terms and Conditions.
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First Name *
Surname *
Email address *
Order will not be processed without a valid email address
Delivery address *
Eircode *
Are you requesting condoms or lubricant? *
Are you over the age of 17? *
I consent that the condoms and/or lubricant I am requesting are for my own personal use and will be delivered to my personal home address.  I agree that all of the above details are correct. I also agree with Sexual Health West Condom distribution policy and the NCDS terms and conditions.
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Terms of Use
For full details of the NCDS terms and conditions please click here
For full details of Sexual Health West Condom distribution policy please click here

Sexual Health West will ensure that personal data will be processed in accordance with the principles of data protection, as described in the Data Protection Acts, 1988 and 2003 and GDPR 2018.
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