Form Builder

Required fields are marked with asterisks (*)

Harm Reduction Supply Order for Community Organizations

ALL COMMUNITY ORGANIZATIONS MUST PLACE ORDERS ON MONDAYS BY THE END OF THE DAY - ALL ORDERS NOT PLACED BY THEN CANNOT BE GUARANTEED DELIVERY UNTIL THE NEXT WEEK.
Organizations must be preauthorized by KFL&A Public Health to order harm reduction supplies.
To order naloxone, organizations must be enrolled in the Ontario Naloxone Program through KFL&A Public Health. All enrolled ONP sites (including police and fire) should use this form to order naloxone.
Naloxone and harm reduction supplies have expiry dates. Remember to rotate your stock. Use oldest stock before the stock from this order.

Name of agency or organization

Your name

Phone number

E-mail address

Address

Delivery instructions (e.g. ring buzzer, location for drop off, hours)

Additional information ( e.g. upcoming event, used sharps disposal pick-up, will pick up order on specified date and time)

Select all required

I need

Harm reduction supplies

Naloxone

Educational resources

Safer sex supplies