NEXT Distro: Apply for FREE Harm Reduction Supplies by Mail
We are committed to your safety and security; this form does not ask for your name, address, or contact info. After submitting this application, please be sure to submit your contact information at nextdistro.org/handleform so we can get in touch!

If you are ONLY looking for naloxone / Narcan, go to nextdistro.org/naloxone. Do not fill out this form.
If you have received a package of harm reduction supplies from us before, do not fill out this form. Instead, contact us!
Email us at info@nextdistro.org or call/text (646) 389-0752
If you have received ONLY naloxone from us in the past, you may continue filling out this form.
This application is for individuals who use drugs. We do not provide supplies to community organizations through this program.
Multiple individuals at the same address may qualify to receive supplies. Please encourage others you know to apply!
Please create a handle. It must be at least 6 characters long and contain no spaces or special characters.

Ensure the handle is one you'll remember and write it down — you will need it for the final step of the application. 

Avoid using your real name or a Twitter/Instagram username. Your handle should not be linked to you in any way.

We will not accept racist / white supremacist handles.
 *
Handle Examples: SoccerFan222, I_Love_Dogs

Please do not use any variation on John/Jane Doe or Joe Schmoe.
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Next Harm Reduction. Report Abuse
Google Forms