Harm Reduction Online Order Form

Stigma-Free, No-Cost, Direct Access to Safe Use Supplies
Use this form to request harm reduction supplies. Please provide your contact information so we can reach you. Orders are processed Monday–Friday; weekend orders will be filled the following Monday. All responses are confidential.

About Us

Sea Change Recovery Community Organization (RCO) and Harm Reduction Center (HRC) is a peer-led nonprofit in Ocean County. Our certified Peer Support Specialists use their lived experience to provide free, confidential peer support, harm reduction services, and community education.
An NJ Harm Reduction Member Card can serve as proof of participation in a syringe services program and may help protect you from legal issues related to possession of injection supplies under state law.
If you are already registered as a harm reduction participant please enter your harm reduction member number here:
To get a new or replacement card, please provide some information to create your unique Harm Reduction ID.
First 2 Letters of Mother or Father First Name:
Last 2 Digits of your SSN
Day and Year of Birth
Are you getting supplies for
Full Name

First NameLast Name
Birthday

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Format: (000) 000-0000.
Email
example@example.com
How would you like us to contact you? After you complete this form, one of our peer support specialists will reach out to confirm your supply quantities and answer any questions you may have.
Let us know where you’re staying. We’re able to provide harm reduction supplies to people in Ocean County, but if you’re elsewhere, we’d be happy to connect you with resources in your area.
Supply Order

No Limits. No Pressure.
Our program is needs-based—no exchange required. Get what you need

One of our peer support specialists will call or text you to confirm the quantities of the supplies.

All supplies come with kits to support safer use.

For example, syringes will come with:
- Alcohol Swabs: For cleaning injection sites and surfaces.
- Cookers: Sterile vessels for mixing substances.
- Sterile Cotton Filters: Used to help filter out particles.
- Sterile Water / Saline: For mixing.
- Small Sharps Container: Puncture‑proof container for safe disposal.
- Fentanyl Test Strips: For detecting the presence of fentanyl.
- Xylazine Test Strips: For detecting the presence of xylazine.
- Non‑Latex Tourniquets: To assist with vein location
- Acidifier – Ascorbic or Citric Acid: Included to help dissolve certain substances.
How would you like to receive your supplies:
Syringes/Needles (Select all types the types that you need)
Safer Smoking & Snorting Supplies (Select all types the types that you need)
Drug Testing Strips (Select all types the types that you need)
Overdose Prevention: Naloxone (aka Narcan)
Specialized kits (Select all types the types that you need)
Do you need help with any of the following?
Are you interested in learning about peer support services
These questions are optional, but your answers help Sea Change secure funding to serve more community members.
Which gender do you identify as? (Optional)
Which race do you identify as? (Optional)
Ethnicity
Recently incarcerated (in the past 1 year)
Substances Used (Optional - Check all that apply)

Other
Modes of Use (Check all that apply)
Should be Empty:

Stigma-Free, No-Cost, Direct Access to Safe Use Supplies