DuPage NARCAN Program (DNP) Contact Information

Community Member Narcan Request

Please note that Narcan can only be provided to IL residents who are at least 18 years of age through this program.
Name*

First NameLast Name
Email*
example@example.com
Phone Number

Area CodePhone Number
How did you hear about our program? (Choose as many as applicable)

HOPE DuPage websiteSocial media (Facebook, Twitter, etc.)Ad (Digital, outdoor, or indoor)Referred by police departmentReferred by fire departmentReferred by treatment providerFriend or family memberOther
How would you like to receive your Narcan kit?*

Pick up at a Public Health CenterBy Mail
Shipping Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

You will be contacted at the email provided to confirm your pick up time, and with instructions for what to do when you arrive for pick up.

Please submit your responses below.
Your Narcan kit will be shipped to you as soon as possible. You should expect to receive the kit within 1-2 weeks.

Please submit your responses below.
Should be Empty:

Community Member Narcan Request