Safer Sex Supplies Request Form
During the pandemic, Family Tree Clinic wants to offer an alternative way to access supplies that may be needed for safer sex practices and family planning.

Please fill out the following form, and we will text or call you when it is ready to arrange pickup. If possible, please pick it up at the clinic and we will ensure social distancing is followed to protect both ourselves and you.

If you are unable to do so, let us know in the form and we will mail you the requested supplies. No one will be turned away for lack of funds and there is no cost for these services, but donations are welcomed!

If you have any questions, feel free to text or call Family Tree Clinic at 651-645-0478.
For general questions about emergency contraception, safer sex, STDs, etc. you can contact the MN Family Planning and STD Hotline - see for more info.

**Due to a higher volume of requests than anticipated and slower postal services, supplies may take a few weeks to arrive.
What supplies would you like? (Check all that apply.) *
If you need non-latex condoms*, dental dams, non-standard sized condoms, or internal condoms please indicate so here. *(availability subject to change)
Are you able to pick up, or do you need it mailed? If you need it mailed, please include a name and address for where we should send it. (Please make sure to include city, state, and zip code in your address.) *
Is it okay for Family Tree Clinic to reach you via text? Please include phone number here. We will only get in touch if we have any questions about your supplies and to arrange for pickup. Please indicate here that it is okay for us to reach out and your phone number. If you require another method of contact, please call the clinic at 651-645-0478 to make arrangements. *
Do you have any privacy concerns we should be aware of to help make sure you safely receive your supplies? Note: packaging will say that it is coming from Family Tree Clinic, but will not have any further identifying information about what is inside.
Any other comments, questions, or concerns?
Never submit passwords through Google Forms.
This form was created inside of Report Abuse