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New Form for Reporting Overdose Reversals - Google Forms

Have you used Naloxone recently? We want to hear from you!

Organizations like Another Day Harm Reduction are required to provide data on overdose reversals to participate in state-funded programs allowing for wide-spread Naloxone distribution. This form contains just 3 questions & takes less than 60 seconds to complete. Your answers significantly benefit programs like ours & allow us to continue to participate in state-funded programs & distribute Naloxone to individuals like YOU!

If you are reporting more than one overdose please fill out one form per incident.

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