Naloxone Awareness Project Volunteer Survey - Nationwide (Pharmacy Visits)

Volunteer Survey

The Naloxone Awareness Project is an outreach campaign to remind pharmacies, pharmacists, and those who work at pharmacies about how they can comply with the standing order to dispense Narcan® (naloxone) without a prescription. We do this by asking volunteers to go to their local pharmacies to ask for and/or purchase naloxone. After the visits, we would like to learn about the experience through this four-minute survey.

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* 1. Your Name (First & Last)

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* 2. What pharmacy did you visit?

Name of Pharmacy

Address

City, State

ZIP Code

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* 3. Did this pharmacy carry naloxone for same day dispensing?

Yes

I don't know

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* 4. Were you asked questions about why you needed naloxone?

Yes

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* 5. Were you readily offered the option of purchasing naloxone as soon as you asked about accessing it?

Yes