Supply Order

TOR Supply Order Form
Tribal Opioid Response Supplies Order Form
What supplies are you in need of?

NarcanFentanyl Test KitsCondomsPlan B Emergency ContraceptiveMedical Lock BagHIV Test KitMedical Disposal BagSafer Injection Kit (Oklahoma Residents Only)Wound Care KitHygiene KitTOR Recovery WorkbookPersonal Sharps ContainerXylazine Test StripsGun LockDental DamsSyphilis Test Kit
Safer Injection Kits include:

-Sterile syringes to reduce risk of getting contracting HIV, hepatitis, and other infections from sharing or reusing needles.

-Sterile Water

-Sterile cooker cup

-Rubber tourniquet

-Fentanyl test kits

-Narcan
Safer Injection kit Warning:

WARNING: The use of this product in correlation with any illegal substance may cause permanent damage to the lungs, heart, brain, kidney, or liver. Other risks include heart attack, stroke, or death. Use by pregnant women may cause fetal injury, premature birth, miscarriage, fetal stroke, birth defects, or death of newborn. Some of the items in this package are considered drug paraphernalia. Engaging in illegal drug activities such as possessing drug paraphernalia may lead to criminal prosecution.
Age (Required for safer injection kits and Plan B)
Name. If you wish to remain anonymous please put "Current Resident"

First NameLast Name
Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Shipping Address
Name is Optional (if you wish to remain anonymous put "current resident"First Name   Last Name
Street Address   Address Line 2   City   State   Zip

Optional: Area Code   Phone Number
If you have any comments about our service or special requests please let us know.
If you know of any overdose reversal that was made with TOR Narcan please list the zip code of the Overdose Reversal as well as how many doses of Narcan they received.
Have you identified fentanyl in a substance using fentanyl test kits provided by TOR?

YesNo
Have you identified Xylazine in a substance using Xylazine test kits provided by TOR?

YesNo
If you have had a direct exposure to HIV within 72 hours, see a provider for PEP services immediately.

"The Syphilis Self-Test is a fingerstick blood test for the detection of antibodies to the bacteria that causes syphilis. if you have ever had syphilis before you will always have antibodies for syphilis. This test is meant for someone who has never had syphilis or does not know if they have ever had it. If you have had syphilis before, you can request for someone to help you get connected with health care provider for testing with sexual health care navigation with the Native Test program by texting "Native Test" to 55251 or visit online at nativetest.org. You can also use this link to find clinic closest to you for expanded STI testing https://locator.hiv.gov/map/73170"

Orders can take up to a few weeks to arrive. For urgent needs for Emergency Contraception (EC) please look at your local resources. EC (Plan B One-Step, Julie, ect.) is what you can receive over the counter without a prescription. These types of pills work best when you take them within 3 days (72 hours) after unprotected sex. The sooner you take them, the better they work. If you are over 165lbs, it has been more than 72 hours since you had unprotected sex, or you missed 2 days of your birth control you might need a prescription for Ella or an IUD. See a provider immediately to see what is right for you.
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TOR Supply Order Form

Tribal Opioid Response Supplies Order Form

Safer Injection kit Warning: