Materials Request Form | Center for Health Education & Wellness

Name*
First Last
E-mail*
Enter campus e-mail address Confirm campus e-mail address
Who/what are you ordering for?*
e.g. Hess Hall
Would you like to pick the materials up from our office or have them delivered?*
Deliveries are made Monday - Friday, 8am - 5pm to on-campus buildings only. Pickup orders should be picked up in the Center for Health Education & Wellness, 1800 Volunteer Blvd., Suite 201. Pickup is available Monday - Friday 8am-5pm (Wednesdays 9am-5pm).
- Pick-up
- Delivery
Where would you like the materials delivered?
Street Address Address Line 2 City State ZIP Code
By what date do you need the materials?*
MM slash DD slash YYYY

Delivery requests must allow two weeks for processing and delivery. Delivery requests that do not allow two weeks advanced notice are not guaranteed to be filled and delivered by the requested date. Delivery is only for on-campus addresses. Pick-up requests must allow one week for processing. Pickup requests that do not allow one week advanced notice are not guaranteed to be filled and ready for pickup by the requested date.
What materials would you like to request?*
- Safer Sex Supplies
- DisposeRx
- Alcohol C.U.P.S. Cards
- Medical Amnesty Cards
Safer Sex Supplies
Safer sex supplies come in assortment packs suitable for different sized groups. For groups larger than 40, please contact the Interpersonal Wellness & Sexual Health Coordinator at kdmcmahan@utk.edu. Safer sex supply orders are for GROUP USE only, not personal use.
- Small (groups of 10 or fewer)
- Medium (groups between 10-20)
- Large (groups between 20-30)
- Extra Large (groups between 30-40)
DisposeRx
Choose the quantity of DisposeRx that is most suitable for your needs. If you prefer a quantity that is not listed as an option, please contact the Alcohol & Other Drug Coordinator at smccall6@utk.edu. Individuals may also visit our front desk to receive a DisposeRx packets.
- 25 packets
- 50 packets
- 75 packets
- 100 packets
If the item you would like is not in the list, please describe it:
How many Alcohol C.U.P.S. cards do you need?*
How many Medical Amnesty cards do you need?*
Hidden
How many Survival Guide to Stress booklets do you need?
Please share any other information that you would like us to know.
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- First Choice
- Second Choice
- Third Choice