Montana Mail Order Supply Program
Please read - our ordering process has changed
Application Process
This application asks for very sensitive health information. Do not put your name or any other identifying information on this form.
The email address you provide is how you will receive notification about your application. We recommend that you create a new free email (ex. protonmail.com) – especially if you’re current email contains any part of your first or last name. We want you to interact with our program as anonymously as possible. Your data is encrypted when transmitted and while stored.
We will connect your order to your address via your unique ‘codeword’. The information on this form will never be stored in the same database as your full name and address. If you have any questions about this process please ask. You may also call and give us your full name and address + your codeword over the phone if that feels more secure. Write your codeword down somewhere safe and do not lose you your email password. We suggest using a password manager like Bitwarden.
If your application is accepted you will be notified via email. Do not share any of the links we send you.
You may request supplies once per month. We cannot guarantee that every request will be honored.
Why we have to do this
Our supplies are limited and federal funding does not support the purchase of syringes or cookers/mixers.
We hope that the data we collect through this program can help us serve more people across more of Montana.
Your answers on this application will be shared anonymously with programs who fund operations like ours, including donors and members of our board. Detailed, honest, and anonymous answers will help us understand the need of your community best. Your feedback will help us prove why this service is needed.
If you need help with your application, please call 406-273-1888 Monday-Wednesday, 10-3PM for assistance. Email [email protected] if you have questions or feedback.
THANK YOU! We appreciate you!
Application
PLEASE NOTE: If you have already been approved, you do not need to fill out this form again.
