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Report an Overdose Reversal

If you used naloxone provided to you by QCHR, fill out this application.  This helps us get more naloxone when you let us know it is being used. Thank you!

*Your information is ALWAYS protected, but if you wish to remain anonymous that is perfectly ok.

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Feel Free to make up a fake name and email address. We don't require this information

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Thanks! You're helping us keep naloxone free for you.

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