Naloxone/Narcan® Request Form

Naloxone/Narcan® Saves Lives by Reversing the Effects of an Overdose

Please complete the following questionnaire to request 2-free Narcan® boxes be mailed to you.

Items included: 2 boxes of Narcan® (each Narcan® box contains 2- 4mg doses of Narcan® Nasal Spray).  

*Please follow the manufacturer’s instructions inside the box.
When you administer Naloxone/Narcan®, always call 911!

T