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NH HPG: Sexual Health Merch Order Form

Hi, there!  We're so happy you've decided to place your order for free sexual health merch! 

1. To get started, please tell us your name and email address.  We will ask for your shipping address on the next page.

Any information you share in this order form will be kept confidential. The NH Department of Health and Human Services and its logistics partner, the Community Health Institute, follow all privacy laws and guidelines to protect your personal health information.

NOTE: Orders can only be mailed to NH residents who are 18 and older.    You may place one order per month.
This question requires a valid email address.
2. Are you are a NH resident over the age of 18? *This question is required.