LGBT Foundation - Anonymous Substance Reporting

Anonymous Substance Reporting
Use this form to anonymously report a substance in Manchester. Keep your answers as close to the original details as possible.
Purchase Details
Where in Manchester was the substance purchased?
Where Was It Purchased - Please State Area
How was the substance purchased?
Do you know where the substance was sourced from?
Where roughly was it sourced from
Substance Details
What type of substance is it?

Other
If known, what form was it in?

Other
If appropriate, do you know the strain name?
Use, Appearance, Effects, and Reporting Reason
Was it taken with any alcohol or other drugs?
Taken With Alcohol or Drugs - Please specify
Describe the appearance (colour, shape, packaging, markings, smell, etc.)
Did you notice anything unusual or concerning?

Other
Unusual or Concerning - Please describe
Did drug use result in an ambulance call out or hospital visit?
Were any effects observed or reported?

Other
Effects Observed or Reported - Please describe
Why are you reporting this substance?

Other
Reporting Substance Reason - Please describe
Anything else you want to share?
Should be Empty:

Anonymous Substance Reporting