This survey is being used to collect information about overdoses and using take home naloxone kits. The survey is not linked to your name or personal health information, and completing will not affect your ability to request a naloxone kit or health services.

Instructions: Please complete the survey to the best of your knowledge. Thank you.
 
 

 
 
 
   
 
 
   
 
 
   
  Note: If you are completing this on behalf of the person who overdosed or the person who responded to the overdose, please complete the form as if they were completing it.
   
 
 
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