Naloxone Survey

Question Title

* 1. Where did you get this Narcan (naloxone) kit?

Marin County Jail Lobby, San Rafael

Marin Social Services: 120 North Redwood, San Rafael

Someone gave me the kit

Question Title

* 2. What do you plan to do with the kit?

Keep it in case it is needed

Give it to someone

Other (please specify)

Question Title

* 3. Have you ever used Narcan to reverse a suspected overdose?

Yes

Question Title

* 4. Would you like us to call you to discuss treatment options?

Yes, call me at:

Question Title

* 5. Will you tell us if you used this Narcan kit? We will not ask your name or track your details.

Yes, Text, email or call me at:

Question Title

* 6. Are you interested in being entered into a monthly drawing for a Safeway gift card?

Yes, if my entry is drawn, text, email or call me at:

Thank you for helping us to save lives through Narcan distribution. For additional information about Narcan and treatment resources, please visit: www.ODFreeMarin.org.