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STI Medication or Condom Ordering Form

STI Medication

Please note the STI Med Program can require up to 10 business days to fill orders. It is not intended for urgent treatment distribution. Consider ordering your medications in advance to help keep your clinic well-stocked and to reduce delay to patient care. If treatment is required immediately, your clinic may need to arrange for a courier. For order pick-up, please follow-up with the Sexual Health Clinic to confirm details at 613-560-6099.

Condoms for your waiting room

Small quantities of condoms (up to 200) and lubricant (up to 100 sachets) may be ordered through this form with your STI Medication order. If your health care clinic requires larger quantities, or if you would like to order only condoms, please visit this link: https://secureforms.ottawapublichealth.ca/Sexual-Health/Condom-Order-Form-English/

What type of order are you requesting?

STI Medication

STI Medication and Condoms

Name of Medical Clinic:

First Name of Ordering Physician or Nurse Practitioner:

Last Name of Ordering Physician or Nurse Practitioner:

Direct Telephone Number:

Email:

Street Address of Medical Clinic:

Suite:

City:

Province:

Postal Code:

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STI Medication or Condom Ordering Form

STI Medication

Condoms for your waiting room

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2-1-1 Ontario

3-1-1 City of Ottawa