Requesting a Naloxone Kit

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Please complete this form after you have watched the Naloxone Training video on the BRiDGES website.

Once you have completed this form, BRiDGES will mail you a kit. Please call us at (315)697-3947 if you do not receive your kit within 2 weeks of submitting this form.

Please note, BRiDGES can only mail Naloxone kits to NY addresses.

If you need a Naloxone Kit faster than the two week time it might take to come in the mail, please call us at (315)697-3947 to see if we can arrange a time for you to pick up the kit at our office in Oneida, NY.

Thank you,

BRiDGES

First Name *

Last Name *

Phone Number

Mailing Address (if you would like your kit mailed) *

Which group best describes you? Please pick the one that best describes your reason for being trained. *

By checking yes, I agree that I am at least 18 years of age. *

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