Instructions: Please complete and submit the form below. We will contact you when your Narcan Emergency Box is ready to be picked up.
Permission: By submitting this form, I confirm that I am an authorized representative of the establishment listed below, and that the site personnel agree to keep a limited supply of Narcan/naloxone on the premises, collect necessary distribution paperwork, and to refer interested individuals to comprehensive community Narcan trainings as schedule permits. I also understand that my site may be listed on the public access listing on the Erie County Opiate Epidemic Task Force website. I agree to visually inspect the Narcan Emergency Box at least once per week and resupply with Narcan as needed.