Good Samaritan Overdose Act wallet card feedback

Thank you in advance for completing our short survey about the Good Samaritan Drug Overdose Act wallet card that you recently ordered or downloaded from our website. We would like to better understand how you are using the card and to make sure the information provided is useful. This survey should only take three to five minutes to complete.

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* 1. The wallet card (select all that apply):

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* 2. The wallet card helped me/my clients (select all that apply):

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* 3. The wallet cards have helped me/my clients during an interaction with emergency responders:

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* 4. Approximately how many wallet cards have you distributed to date?

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* 5. Over what period of time did you distribute these wallet cards?

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* 6. Overall, how useful did you and/or your clients find the information on the wallet cards?

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* 7. Do you have any additional feedback you would like to share?

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* 8. What is the name of your organization?

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* 9. If you would like to provide further feedback, please provide your name and email address below:

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