*1.Is there a possibility of a high risk situation involving Fentanyl, where having access to Fentanyl Test Strips could prevent an overdose?(Required.)

Yes

No

*2.How many test strips do you need? One new strip is needed for every "dose" or substance tested.(Required.)

1-2

2-4

4-6

As many as you can provide-high risk situation

*3.Where would you like us to send your test strips? This information is confidential and will come in an envelope from Prevention Network. (Required.)

Name (Can use first initial only)

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

*4.Are you interested in receiving Narcan Nasal spray training? Narcan can reverse an opioid overdose for 30-90 minutes and allow time to get a person medical attention. Trainings are 15 minutes or less and can be be conducted by phone or Zoom.(Required.)

Yes

No