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Partnering Distribution Sites
Do you work at a place in or near New Haven that provides free naloxone (Narcan)?
If yes,
please fill out this form! We will add your location to the naloxone map (Glowhopper Go).
Are you a member of a distribution site interested in being included on the online distribution map?
*
Are you a member of a distribution site interested in being included on the online distribution map?
A
Yes
B
No
Full Name
Email
Phone Number
Organization
What platform would you prefer to be contacted?
What platform would you prefer to be contacted?
A
Email
B
Apple messages
C
What's App
D
Signal
Do you have any naloxone site location information you want us to include on the map?
Click to choose a file or drag here
Size limit: 10 MB
What are your organization's hours of operation?
*
Who does this organization serve?
*
Is this location wheelchair accessible?
*
Is this location wheelchair accessible?
A
Yes
B
No
Does this location have police presence
*
Does this location have police presence
A
Yes
B
No
Submit
