Fentanyl Strips Request Form
Fill out to request resources distribution for your organization. 

If you have any questions, comments, or concerns please contact us by email or text. 
Email: m.dufault@endoverdose.net
Phone Number: 760-579-1166

Learn more about EndOverdose:
https://tinyurl.com/EndODatUW
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Select the organization type you are requesting resources for.  *
How many fentanyl test strips do you need? *
About how many people are the testing strips for? *
Organization Name *
Do you have a location accessible to members for the fentanyl test strips or will you be distributing to each member individually? *
Primary Contact - Name *
Primary Contact - Position
 *
Primary Contact - Number and/or Email
 *
Optional Secondary Contact - Name
Optional Secondary Contact - Position
Optional Secondary Contact - Name and/or Email
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