{"id":11426,"date":"2017-10-17T13:51:07","date_gmt":"2017-10-17T13:51:07","guid":{"rendered":"http:\/\/bferrign.wdev.rochester.edu\/uhs\/?page_id=11426"},"modified":"2025-04-30T08:34:18","modified_gmt":"2025-04-30T12:34:18","slug":"safesexexpress","status":"publish","type":"page","link":"https:\/\/www.rochester.edu\/uhs\/healthpromotion\/safesexexpress\/","title":{"rendered":"Safe Sex Express Order Form"},"content":{"rendered":"<h2><strong>What is the Safe Sex Express?<\/strong><\/h2>\n<p>The Safe Sex Express is a program that delivers safer sex supplies and information to Rochester students\u2019 CMC boxes. The program was created by students on the UR Student Health Advisory Committee (URSHAC) in the spring of 2015. The Safe Sex Express makes around 100 deliveries each month throughout the academic year!<\/p>\n<h2><strong>Here are a few things the program strives for:<\/strong><\/h2>\n<ul>\n<li>To provide anonymous and cost-free access to safer sex supplies such as condoms, lube, and dental dams.<\/li>\n<li>To provide information on topics such as proper condom use, consent, and STI testing.<\/li>\n<li>To increase utilization across all Rochester communities, including first year students, LGBTQ+ students, and Eastman School of Music students.<\/li>\n<\/ul>\n<h2><strong>How does it work?<\/strong><\/h2>\n<p>Any Rochester student with a CMC box can place an order using our request form. Options include:<\/p>\n<ul>\n<li>External condoms (AKA male condoms, many varieties available, including latex-free)<\/li>\n<li>Internal condoms (AKA female condoms)<\/li>\n<li>Water-based &amp; silicone-based lubricant<\/li>\n<li>Dental dams<\/li>\n<li>Finger cots<\/li>\n<\/ul>\n<p>Order requests are checked and fulfilled twice weekly. You\u2019ll receive your supplies and sexual health information in a discreet package delivered to your CMC box within 5-7 business days.<\/p>\n<p>If you need safer sex supplies while you wait for your order to arrive, you can find those for free in the Campus Information Center, the first floor UHS waiting room, the Health Promotion Office, the Wellness on Demand vending machine at UHS, and the Paul J. Burgett Intercultural Center. You may also purchase them at Hillside, as well as off campus locations such as CVS, Wegmans, Walmart, and more.<\/p>\n<h2><strong>Why is this program important?<\/strong><\/h2>\n<p>The need for the Safe Sex Express program is supported by the University of Rochester\u2019s 2024 National College Health Assessment results:<\/p>\n<ul>\n<li>In the past 12 months, 38.5% of undergraduate students have engaged in vaginal intercourse, 47.6% in oral sex, and 7.2% in anal sex.<\/li>\n<li>Of those sexually active students, only 6.6% always used protection (condom, dental dam, etc.) during oral sex, and only about 41.2% always used protection during vaginal intercourse.<\/li>\n<li>Over 26% of those that reported having vaginal intercourse in the last 12 months indicated that they (or their partner) have used emergency contraception at least once.<\/li>\n<\/ul>\n<h2><strong>How can I learn more about safer sex practices?<\/strong><\/h2>\n<ul>\n<li>Learn <a href=\"https:\/\/www.rochester.edu\/uhs\/healthpromotion\/safesexexpress\/supplies\/\">how to properly use various safer sex supplies<\/a>.<\/li>\n<li>Get the details on <a href=\"https:\/\/www.plannedparenthood.org\/learn\/stds-hiv-safer-sex\">STDs and STIs<\/a>.<\/li>\n<li>See what <a href=\"https:\/\/www.plannedparenthood.org\/learn\/teens\/sex\/all-about-consent\">consent<\/a> looks like in real world situations.<\/li>\n<\/ul>\n<hr \/>\n<p>To place an order for safe sex supplies, please complete the form below. Orders are packaged twice a week, then sent to the River Campus mail center or Eastman SLC. From there, the mail center will place them in your mailbox. You should expect to receive your order within 5-7 <em>business days.\u00a0<\/em>If you are an ESM student, your order may take a little longer to arrive.<\/p>\n<p>If you have a special request (e.g. a certain quantity, extra of a certain item, latex allergy, etc.), please place that in the comments and special requests box.<\/p>\n<p><em>If you need safer sex supplies while you wait for your order to arrive, you can find those for free in the Campus Information Center, the first floor UHS waiting room, the Health Promotion Office, the Wellness on Demand vending machine at UHS, and the Paul J. Burgett Intercultural Center. You may also purchase them at Hillside, as well as off campus locations such as CVS, Wegmans, Walmart, and more.<\/em><\/p>\n<p><strong>If you are graduating this year, the last day to place an order is May 5th.\u00a0<\/strong><\/p>\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 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d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n<div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_162' style='display:none'>\n<div class='gform_heading'>\n<h3 class=\"gform_title\">Safe Sex Express Order Form Submission<\/h3>\n<p class='gform_description'>\n<\/p><\/div>\n<form method='post' enctype='multipart\/form-data'  id='gform_162'  novalidate action='\/uhs\/wp-json\/wp\/v2\/pages\/11426' data-formid='162' novalidate>\n<div class='gform-body gform_body'>\n<ul id='gform_fields_162' class='gform_fields top_label form_sublabel_below description_below validation_below'>\n<li id=\"field_162_1\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_162_1'>What is your mailbox number (CMC or CPU)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_text'><input name='input_1' id='input_162_1' type='text' value='' class='medium'  aria-describedby=\"gfield_description_162_1\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div>\n<div class='gfield_description' id='gfield_description_162_1'>If you are an Eastman School of Music student, please specify that here as well. <\/div>\n<\/li>\n<li id=\"field_162_3\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf-checkbox\"  data-field-class=\"gf-checkbox\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >I would like to request: (choose one or more items below)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_checkbox'>\n<ul class='gfield_checkbox' id='input_162_3'>\n<li class='gchoice gchoice_162_3_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.1' type='checkbox'  value='External Condoms (AKA Male Condoms)'  id='choice_162_3_1'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_3_1' id='label_162_3_1' class='gform-field-label gform-field-label--type-inline'>External Condoms (AKA Male Condoms)<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_3_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.2' type='checkbox'  value='Internal Condoms (AKA Female Condoms)'  id='choice_162_3_2'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_3_2' id='label_162_3_2' class='gform-field-label gform-field-label--type-inline'>Internal Condoms (AKA Female Condoms)<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_3_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.3' type='checkbox'  value='Silicone-Based Lubricant'  id='choice_162_3_3'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_3_3' id='label_162_3_3' class='gform-field-label gform-field-label--type-inline'>Silicone-Based Lubricant<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_3_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.4' type='checkbox'  value='Dental Dam'  id='choice_162_3_4'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_3_4' id='label_162_3_4' class='gform-field-label gform-field-label--type-inline'>Dental Dam<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_3_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.5' type='checkbox'  value='Finger Cots'  id='choice_162_3_5'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_3_5' id='label_162_3_5' class='gform-field-label gform-field-label--type-inline'>Finger Cots<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_3_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.6' type='checkbox'  value='Pregnancy Test'  id='choice_162_3_6'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_3_6' id='label_162_3_6' class='gform-field-label gform-field-label--type-inline'>Pregnancy Test<\/label>\n\t\t\t\t\t\t\t<\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li id=\"field_162_15\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf-checkbox\"  data-field-class=\"gf-checkbox\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Which type of external condom would you prefer?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_checkbox'>\n<ul class='gfield_checkbox' id='input_162_15'>\n<li class='gchoice gchoice_162_15_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.1' type='checkbox'  value='Lifestyle Ultra Sensitive'  id='choice_162_15_1'   aria-describedby=\"gfield_description_162_15\"\/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_15_1' id='label_162_15_1' class='gform-field-label gform-field-label--type-inline'>Lifestyle Ultra Sensitive<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_15_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.2' type='checkbox'  value='Flavored'  id='choice_162_15_2'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_15_2' id='label_162_15_2' class='gform-field-label gform-field-label--type-inline'>Flavored<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_15_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.3' type='checkbox'  value='Colored'  id='choice_162_15_3'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_15_3' id='label_162_15_3' class='gform-field-label gform-field-label--type-inline'>Colored<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_15_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.4' type='checkbox'  value='Trojan Magnum'  id='choice_162_15_4'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_15_4' id='label_162_15_4' class='gform-field-label gform-field-label--type-inline'>Trojan Magnum<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_15_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.5' type='checkbox'  value='Latex-Free'  id='choice_162_15_5'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_15_5' id='label_162_15_5' class='gform-field-label gform-field-label--type-inline'>Latex-Free<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_15_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.6' type='checkbox'  value='Non-lubricated condom'  id='choice_162_15_6'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_15_6' id='label_162_15_6' class='gform-field-label gform-field-label--type-inline'>Non-lubricated condom<\/label>\n\t\t\t\t\t\t\t<\/li>\n<\/ul>\n<\/div>\n<div class='gfield_description' id='gfield_description_162_15'>Requests are fulfilled as supplies allow, and substitutions may be made. Please ONLY request latex-free if you need them. <\/div>\n<\/li>\n<li id=\"field_162_16\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf-checkbox\"  data-field-class=\"gf-checkbox\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Which flavor of external condom would you prefer?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_checkbox'>\n<ul class='gfield_checkbox' id='input_162_16'>\n<li class='gchoice gchoice_162_16_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.1' type='checkbox'  value='Banana'  id='choice_162_16_1'   aria-describedby=\"gfield_description_162_16\"\/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_16_1' id='label_162_16_1' class='gform-field-label gform-field-label--type-inline'>Banana<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_16_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.2' type='checkbox'  value='Strawberry'  id='choice_162_16_2'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_16_2' id='label_162_16_2' class='gform-field-label gform-field-label--type-inline'>Strawberry<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_16_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.3' type='checkbox'  value='Vanilla'  id='choice_162_16_3'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_16_3' id='label_162_16_3' class='gform-field-label gform-field-label--type-inline'>Vanilla<\/label>\n\t\t\t\t\t\t\t<\/li>\n<\/ul>\n<\/div>\n<div class='gfield_description' id='gfield_description_162_16'>Requests are fulfilled as supplies allow, and substitutions may be made.<\/div>\n<\/li>\n<li id=\"field_162_14\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf-checkbox\"  data-field-class=\"gf-checkbox\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Which flavor dental dams would you prefer?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_checkbox'>\n<ul class='gfield_checkbox' id='input_162_14'>\n<li class='gchoice gchoice_162_14_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.1' type='checkbox'  value='Banana'  id='choice_162_14_1'   aria-describedby=\"gfield_description_162_14\"\/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_14_1' id='label_162_14_1' class='gform-field-label gform-field-label--type-inline'>Banana<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_14_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.2' type='checkbox'  value='Grape'  id='choice_162_14_2'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_14_2' id='label_162_14_2' class='gform-field-label gform-field-label--type-inline'>Grape<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_14_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.3' type='checkbox'  value='Mint'  id='choice_162_14_3'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_14_3' id='label_162_14_3' class='gform-field-label gform-field-label--type-inline'>Mint<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_14_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.4' type='checkbox'  value='Strawberry'  id='choice_162_14_4'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_14_4' id='label_162_14_4' class='gform-field-label gform-field-label--type-inline'>Strawberry<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_14_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.5' type='checkbox'  value='Vanilla'  id='choice_162_14_5'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_14_5' id='label_162_14_5' class='gform-field-label gform-field-label--type-inline'>Vanilla<\/label>\n\t\t\t\t\t\t\t<\/li>\n<\/ul>\n<\/div>\n<div class='gfield_description' id='gfield_description_162_14'>Requests are fulfilled as supplies allow, and substitutions may be made.<\/div>\n<\/li>\n<li id=\"field_162_5\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf-radio\"  data-field-class=\"gf-radio\" ><label class='gfield_label gform-field-label' >What is your class year?<\/label>\n<div class='ginput_container ginput_container_radio'>\n<ul class='gfield_radio' id='input_162_5'>\n<li class='gchoice gchoice_162_5_0'>\n\t\t\t\t<input name='input_5' type='radio' value='First Year'  id='choice_162_5_0'    \/><br \/>\n\t\t\t\t<label for='choice_162_5_0' id='label_162_5_0' class='gform-field-label gform-field-label--type-inline'>First Year<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_5_1'>\n\t\t\t\t<input name='input_5' type='radio' value='Sophomore'  id='choice_162_5_1'    \/><br \/>\n\t\t\t\t<label for='choice_162_5_1' id='label_162_5_1' class='gform-field-label gform-field-label--type-inline'>Sophomore<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_5_2'>\n\t\t\t\t<input name='input_5' type='radio' value='Junior'  id='choice_162_5_2'    \/><br \/>\n\t\t\t\t<label for='choice_162_5_2' id='label_162_5_2' class='gform-field-label gform-field-label--type-inline'>Junior<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_5_3'>\n\t\t\t\t<input name='input_5' type='radio' value='Senior'  id='choice_162_5_3'    \/><br \/>\n\t\t\t\t<label for='choice_162_5_3' id='label_162_5_3' class='gform-field-label gform-field-label--type-inline'>Senior<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_5_4'>\n\t\t\t\t<input name='input_5' type='radio' value='Take Five'  id='choice_162_5_4'    \/><br \/>\n\t\t\t\t<label for='choice_162_5_4' id='label_162_5_4' class='gform-field-label gform-field-label--type-inline'>Take Five<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_5_5'>\n\t\t\t\t<input name='input_5' type='radio' value='Graduate Student'  id='choice_162_5_5'    \/><br \/>\n\t\t\t\t<label for='choice_162_5_5' id='label_162_5_5' class='gform-field-label gform-field-label--type-inline'>Graduate Student<\/label>\n\t\t\t<\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li id=\"field_162_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf-radio\"  data-field-class=\"gf-radio\" ><label class='gfield_label gform-field-label' >On a scale of one to ten, with one being the most dissatisfied and 10 being the most satisfied, what is your overall satisfaction with the Safe Sex Express program?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_radio'>\n<ul class='gfield_radio' id='input_162_12'>\n<li class='gchoice gchoice_162_12_0'>\n\t\t\t\t<input name='input_12' type='radio' value='1'  id='choice_162_12_0'    \/><br \/>\n\t\t\t\t<label for='choice_162_12_0' id='label_162_12_0' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_12_1'>\n\t\t\t\t<input name='input_12' type='radio' value='2'  id='choice_162_12_1'    \/><br \/>\n\t\t\t\t<label for='choice_162_12_1' id='label_162_12_1' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_12_2'>\n\t\t\t\t<input name='input_12' type='radio' value='3'  id='choice_162_12_2'    \/><br \/>\n\t\t\t\t<label for='choice_162_12_2' id='label_162_12_2' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_12_3'>\n\t\t\t\t<input name='input_12' type='radio' value='4'  id='choice_162_12_3'    \/><br \/>\n\t\t\t\t<label for='choice_162_12_3' id='label_162_12_3' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_12_4'>\n\t\t\t\t<input name='input_12' type='radio' value='5'  id='choice_162_12_4'    \/><br \/>\n\t\t\t\t<label for='choice_162_12_4' id='label_162_12_4' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_12_5'>\n\t\t\t\t<input name='input_12' type='radio' value='6'  id='choice_162_12_5'    \/><br \/>\n\t\t\t\t<label for='choice_162_12_5' id='label_162_12_5' class='gform-field-label gform-field-label--type-inline'>6<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_12_6'>\n\t\t\t\t<input name='input_12' type='radio' value='7'  id='choice_162_12_6'    \/><br \/>\n\t\t\t\t<label for='choice_162_12_6' id='label_162_12_6' class='gform-field-label gform-field-label--type-inline'>7<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_12_7'>\n\t\t\t\t<input name='input_12' type='radio' value='8'  id='choice_162_12_7'    \/><br \/>\n\t\t\t\t<label for='choice_162_12_7' id='label_162_12_7' class='gform-field-label gform-field-label--type-inline'>8<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_12_8'>\n\t\t\t\t<input name='input_12' type='radio' value='9'  id='choice_162_12_8'    \/><br \/>\n\t\t\t\t<label for='choice_162_12_8' id='label_162_12_8' class='gform-field-label gform-field-label--type-inline'>9<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_12_9'>\n\t\t\t\t<input name='input_12' type='radio' value='10'  id='choice_162_12_9'    \/><br \/>\n\t\t\t\t<label for='choice_162_12_9' id='label_162_12_9' class='gform-field-label gform-field-label--type-inline'>10<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_12_10'>\n\t\t\t\t<input name='input_12' type='radio' value='Not sure yet - this is my first order.'  id='choice_162_12_10'    \/><br \/>\n\t\t\t\t<label for='choice_162_12_10' id='label_162_12_10' class='gform-field-label gform-field-label--type-inline'>Not sure yet - this is my first order.<\/label>\n\t\t\t<\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li id=\"field_162_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf-radio\"  data-field-class=\"gf-radio\" ><label class='gfield_label gform-field-label' >Because of the Safe Sex Express program, I am more likely to practice safe sex.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>\n<div class='ginput_container ginput_container_radio'>\n<ul class='gfield_radio' id='input_162_13'>\n<li class='gchoice gchoice_162_13_0'>\n\t\t\t\t<input name='input_13' type='radio' value='Strongly Disagree'  id='choice_162_13_0'    \/><br \/>\n\t\t\t\t<label for='choice_162_13_0' id='label_162_13_0' class='gform-field-label gform-field-label--type-inline'>Strongly Disagree<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_13_1'>\n\t\t\t\t<input name='input_13' type='radio' value='Disagree'  id='choice_162_13_1'    \/><br \/>\n\t\t\t\t<label for='choice_162_13_1' id='label_162_13_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_13_2'>\n\t\t\t\t<input name='input_13' type='radio' value='Neutral'  id='choice_162_13_2'    \/><br \/>\n\t\t\t\t<label for='choice_162_13_2' id='label_162_13_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_13_3'>\n\t\t\t\t<input name='input_13' type='radio' value='Agree'  id='choice_162_13_3'    \/><br \/>\n\t\t\t\t<label for='choice_162_13_3' id='label_162_13_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_13_4'>\n\t\t\t\t<input name='input_13' type='radio' value='Strongly Agree'  id='choice_162_13_4'    \/><br \/>\n\t\t\t\t<label for='choice_162_13_4' id='label_162_13_4' class='gform-field-label gform-field-label--type-inline'>Strongly Agree<\/label>\n\t\t\t<\/li>\n<\/ul>\n<\/div>\n<\/li>\n<li id=\"field_162_22\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf-checkbox\"  data-field-class=\"gf-checkbox\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Would you like to add Fentanyl or Xylazine test strips to your order?<\/label>\n<div class='ginput_container ginput_container_checkbox'>\n<ul class='gfield_checkbox' id='input_162_22'>\n<li class='gchoice gchoice_162_22_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.1' type='checkbox'  value='Fentanyl'  id='choice_162_22_1'   aria-describedby=\"gfield_description_162_22\"\/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_22_1' id='label_162_22_1' class='gform-field-label gform-field-label--type-inline'>Fentanyl<\/label>\n\t\t\t\t\t\t\t<\/li>\n<li class='gchoice gchoice_162_22_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.2' type='checkbox'  value='Xylazine'  id='choice_162_22_2'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_162_22_2' id='label_162_22_2' class='gform-field-label gform-field-label--type-inline'>Xylazine<\/label>\n\t\t\t\t\t\t\t<\/li>\n<\/ul>\n<\/div>\n<div class='gfield_description' id='gfield_description_162_22'> There has been a major rise in illicit drugs being laced with Fentanyl all over the nation. These test strips specifically screen for Fentanyl using a small sample of the illicit drug you may choose to consume. Even a pin prick of Fentanyl can cause an overdose. These test strips are a harm-reduction strategy to help our community avoid overdoses due to Fentanyl.<br \/>\nXylazine is a non-opioid tranquilizer linked to overdoses and deaths. Xylazine has been found in the illegal drug supply and its presence is increasing. It is especially dangerous when mixed with fentanyl. Since xylazine is not an opioid, Narcan will not reverse an overdose. Because of this, testing your drugs and seeking medical attention if needed is crucial.<\/div>\n<\/li>\n<li id=\"field_162_6\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_162_6'>What is your email address?<\/label>\n<div class='ginput_container ginput_container_text'><input name='input_6' id='input_162_6' type='text' value='' class='medium'  aria-describedby=\"gfield_description_162_6\"    aria-invalid=\"false\"   \/><\/div>\n<div class='gfield_description' id='gfield_description_162_6'>Email is optional, but please provide if you'd like to receive a message when your order has been filled and sent to the mail center. <\/div>\n<\/li>\n<li id=\"field_162_17\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf-textarea\"  data-field-class=\"gf-textarea\" ><label class='gfield_label gform-field-label' for='input_162_17'>Any comments or special requests?<\/label>\n<div class='ginput_container ginput_container_textarea'><textarea name='input_17' id='input_162_17' class='textarea medium'  aria-describedby=\"gfield_description_162_17\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div>\n<div class='gfield_description' id='gfield_description_162_17'>Quantity, extra of a certain item, latex allergy, etc.<\/div>\n<\/li>\n<li id=\"field_162_21\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf-radio\"  data-field-class=\"gf-radio\" ><label class='gfield_label gform-field-label' >I feel comfortable picking up my Safe Sex Express order from the mailroom.<\/label>\n<div class='ginput_container ginput_container_radio'>\n<ul class='gfield_radio' id='input_162_21'>\n<li class='gchoice gchoice_162_21_0'>\n\t\t\t\t<input name='input_21' type='radio' value='Strongly agree'  id='choice_162_21_0'    \/><br \/>\n\t\t\t\t<label for='choice_162_21_0' id='label_162_21_0' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_21_1'>\n\t\t\t\t<input name='input_21' type='radio' value='Agree'  id='choice_162_21_1'    \/><br \/>\n\t\t\t\t<label for='choice_162_21_1' id='label_162_21_1' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_21_2'>\n\t\t\t\t<input name='input_21' type='radio' value='Neither agree nor disagree'  id='choice_162_21_2'    \/><br \/>\n\t\t\t\t<label for='choice_162_21_2' id='label_162_21_2' class='gform-field-label gform-field-label--type-inline'>Neither agree nor disagree<\/label>\n\t\t\t<\/li>\n<li class='gchoice gchoice_162_21_3'>\n\t\t\t\t<input 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The Safe Sex Express is a program that delivers safer sex supplies and information to Rochester students\u2019 CMC boxes. The program was created by&hellip;<\/p>\n","protected":false},"author":192,"featured_media":0,"parent":206,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-11426","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Safe Sex Express Order Form - University Health Service<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.rochester.edu\/uhs\/healthpromotion\/safesexexpress\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Safe Sex Express Order Form - University Health Service\" \/>\n<meta property=\"og:description\" content=\"What is the Safe Sex Express? 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