Free Supplies Order

Order Form - Overdose Prevention Supplies

Naloxone, Fentanyl Test Strips, Sexual Health Kits
Please use this form to request free Narcan, fentanyl test strips, or sexual health kits for pickup at our office. Pickup details will be emailed to you automatically once you submit the form.

For any questions or concerns, please contact staff directly at info@sacopioidcoalition.org

All are welcome to pickup supplies with no questions asked. You can fill out the form however you like - information does not have to be true.
First Name*
Last Name
Phone Number
Please enter a valid phone number.
Email Address*
example@example.com
Are you associated with an organization or professional entity?
What items would you like to pickup?*

Naloxone kits - Bags with 1 naloxone box, CPR face shield, alcohol wipe, brochureNaloxone boxes - 1 naloxone box (2 doses of naloxone)Fentanyl test stripsSexual health kits - condoms, lubricant packets, dental dams, educational materials
How many naloxone kits or boxes would you like?
How many fentanyl test strips would you like?
How many sexual health kits would you like?
If request is larger than 100-300 kits, please specify below how many you would like:
Please note that supply of sexual health kit is limited to 15 per order at this time. Fentanyl test strips and naloxone have no order limit.
Would you like to talk to a staff member for a short naloxone training or to discuss treatment resources?

Yes, naloxone trainingYes, treatment or overdose prevention resourcesNo - just a pickup
When would you like to pick up the supplies?*
Should be Empty:

Order Form - Overdose Prevention Supplies