WSHA New Materials Order Form

WSHA Order Form

New Starts with One Educational Materials
Order new naloxone educational materials for your hospital at no cost!

WSHA has partnered with the Starts with One campaign, an opioid misuse prevention campaign from the WA Health Care Authority, to develop three new materials for hospitals:
- Naloxone rack card
- Naloxone prescription handout
- Conversation guide on responsible opioid use
Fill out the form below to place an order and request specific quantities for your health care facility. The campaign will ship requested quantities directly to your facility, free of charge.

Please submit your order by the end of February 2026 to receive materials in the next 1-2 months. Orders submitted after February will be included in our next fulfillment cycle in the summer of 2026.
Contact Name*

First NameLast Name
Hospital or Facility Name*
Shipping Address*

Street Address

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CityState / ProvincePostal / Zip Code

Naloxone Rack Card (for patients)

This folding rack card explains what naloxone is, why carrying it matters, how it works, and where to get it.

Suggested use cases: hand to patients prescribed opioids, distribute in ED settings, and/or place in waiting rooms or exam rooms.

Click here to preview the rack card's full content.
Naloxone Rack Card - Select Quantity

Naloxone Prescription Handout (for patients)

This postcard-sized patient handout covers the basics of naloxone and explains that it is standard to receive naloxone along with an opioid prescription.

Suggested use cases: for providers and pharmacists to give patients along with their opioid and naloxone prescription.

Click here to preview the handout's full content.
Naloxone Prescription Handout - Select Quantity*
*If your hospital has a pharmacy, consider ordering extra prescription handouts to display near the prescription pickup area.

Conversation Guide Table Tent (for providers)

This foldable conversation guide stands upright on desks, offering a quick-reference checklist for providers to use when discussing responsible opioid use with patients receiving an opioid prescription.

Suggested use cases: place on provider desks, use during patient appointments when prescribing opioids, and keep in exam rooms to prompt conversations.
Conversation Guides - Select Quantity
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