CLDit Lock Box Request
Where do you live or work in TN?
I do not live in Tennessee
Please list your zip code
Are your meds secure?
Check all that apply
I do not have a way to lock up my prescription or over-the-counter meds
I do not count my prescription or over-the-counter meds
I have children/teenagers living in or visiting my home
I have visitors in my home
I have had someone take my medication without my permission
If your home is at risk (based on two or more of the above responses), please provide contact information.
You may also provide any other information you want considered in your request.
If you live in Sullivan County and have not been contacted within a week, please call Alice at 742-742-2991.
Never submit passwords through Google Forms.
This form was created inside of Scadcoalition.org.
Terms of Service