Order Supplies


Central Montana Family Planning

505 W. Main Street
Suite #108
Lewistown, MT 59457
Phone & Fax: 406.535.8811
Toll-Free: 877.421.8646

Hours of Operation:
Monday - Thursday: 8 AM to 5 PM
Fridays: 8 AM to Noon





To request supplies (such as condoms or refills of your birth control method) please use the following form:

* = Required. Information must be valid for your request to be filled in a timely manner.
Please Note: Any supplies picked up at fifteen minutes to our closing time (i.e. 4:45 PM or later, 11:45 AM or later on Fridays) will be assessed a late charge.

Not filling out your request completely as required will delay your request.

Please allow 24 business hours from the date of your request for your request to be fulfilled.
Thank you.


*Your First & Last Name:

*Your Birthdate:

*Your E-Mail Address:

*Your Phone #:

*Amount Requested:

*Pick Up Date (Next Business Day, 24 hours later) *Pick Up Time:
or *To Be Mailed? (Yes or No):

*What's Your Request:

Comments:

*Type "smartmove" in this box to prove you're a human being:

~ Other Concerns ~

Personal, birth control method, healthcare and/or education-related questions may be directed to:
Central Montana Family Planning Health Educator
Central Montana Family Planning Registered Nurse

If you'd like the Health Educator or the Registered Nurse to contact you, just mention it in the comments section of the form.

ALL CORRESPONDENCE IS CONFIDENTIAL!