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New Form for Reporting Overdose Reversals - Google Forms

Have you used Naloxone recently? We want to hear from you!


It takes less than 60 seconds to answer 3 questions on our Overdose Reversal Reporting Form. Your answers significantly benefit programs like ours & allow us to continue to participate in state-funded programs & distribute Naloxone to individuals like YOU!


If you are reporting more than one overdose please fill out one form per incident.


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Organization Information

Harm Reduction Circle is a federally recognized 501(c)(3) Nonprofit Organization.

Head Office

PO Box 5564, Irvine, CA 92616, USA

Registered Charity:

87-3878214

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