Condom Request Form

CCDPH is pleased to offer condoms through the mail free of charge to residents of suburban Cook County only. (Residents of Chicago, please click here). There is a limit of 20 condoms and the addresses must be in suburban Cook County, excluding Chicago, Evanston, Skokie, Oak Park, and Stickney Township, since those cities have their own state-certified health departments and are outside CCDPH's jurisdiction. Due to limited supply, requests for more than 20 condoms will still be filled; however, with 20 condoms only. Requests outside CCDPH's jurisdiction will not be acknowledged. Thank you for your cooperation.