Thank you for coordinating with your local health department to ensure that our community has access to naloxone when it's needed. We are doing an annual survey to see what our local organizations needs are surrounding naloxone training and distribution. Please provide an update to your current naloxone status by answering the questions below. This survey should take less than five minutes.

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* 1. What is the name of your organization?

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* 2. What county are you located in?

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* 3. Does your organization currently have Naloxone?

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* 4. If yes, check the following that applies to your organization's use of naloxone:

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* 5. Where do you receive Naloxone from?

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* 6. Would you like assistance with any of the following regarding Naloxone?

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* 7. Who should we contact from your organization in the future regarding naloxone distribution?

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* 8. Please provide a contact email address:

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