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 Naloxone Kit Site Registration  
 This information is collected for operational and program evaluation purposes and intended for community programs. Pharmacies and Medical First Responder agencies interested in distribution can find information at www.ahs.ca/naloxone .

Please note that Naloxone Kits can be ordered once the registration process is completed, which can take 7-10 business days. 
 

 
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Enter the name of the Site for which you will be ordering Naloxone Kits.
 
   
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Please use capital letters and no spaces (e.g. T2N3N8). Database is case/format sensitive.
 
   
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This individual will be the only person who will be ordering Naloxone kits. Please use the Site Registration Update form whenever there is a change in the Primary Contact information.
 
   
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This primary contact email address be used as part of the site identification for ordering Naloxone kits. Please use the Update Site Information form whenever there is a change in the Primary Contact information.
 
   
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List the 24 hour clock time (e.g. 0800) your site starts distributing Naloxone kits.
 
              
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  Survey Tracking Information
   
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