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Rooted Reproductive Support of SEK Request

The request form for the MOBILE PANTRY can be found here ➡️ https://tally.so/r/b5v9zo

Name

How did you hear about us?

Do you live in Wilson County, KS?

Do you live in Wilson County, KS?
A
Do you live in Wilson County, KS?
B
Please note that Allen & Montgomery Counties ONLY HAVE PLAN B.

Have you received products from us before?

Have you received products from us before?
A
Have you received products from us before?
B

What items are you in need of?

Prevention

Prevention

Period Products

Period Products

Medications

Medications

Trying to Conceive

Trying to Conceive

Postpartum Products

Postpartum Products

Personal Hygiene Items

Personal Hygiene Items

Other

Other

Is this a pick up or drop off?

Is this a pick up or drop off?
A
B

If a drop-off, what is the location of the drop-off?

Pick-up location is in Neodesha, KS. Please fill out the contact information below so we can arrange pick-up details.

Contact Information :

Please share one preferred method of communication so we can coordinate pickup or drop-off.

Please share one preferred method of communication so we can coordinate pickup or drop-off.
A
B
C

After selecting one option, please enter your contact details in the field below.

Please allow 24-36 hours for follow up communication.
Rooted Reproductive Support of SEK is a community-powered mutual aid project and does not provide medical care, diagnosis, treatment, or medical advice. Any information provided is for educational purposes only. Individuals are responsible for following all manufacturer instructions and warnings for over-the-counter medications. For medical questions or concerns, consult a licensed healthcare professional.