Tanana Chiefs Conference Division of Wellness and Prevention Opioid Harm Reduction Request Form

Available for anyone living within the Tanana Chiefs Region

Please help us by providing some general information

Naloxone Opioid Overdose Reversal Spray

Deterra- Safe Medication Disposal Pouches

Both Naloxone and Deterra

Fentanyl and/or Xylazine Testing Strips

All the above

First & Last Name *

Professional Position (if applicable to request)

Mailing Address for kits

City/Town

Zip code

Phone number or e-mail if we need to contact you *