Naloxone Request Form for Restaurant & Hospitality Industry

Welcome to our Naloxone Request Form for the Restaurant, Hospitality, and Tourism Industry. In The Weeds understands the critical need for naloxone accessibility and training in these sectors. Naloxone can be a lifesaver during opioid overdose emergencies, underscoring the importance of safe administration knowledge. We encourage establishments to request naloxone and training for their staff.

In The Weeds specializes in comprehensive naloxone administration training tailored for the restaurant, hospitality, and tourism sectors. If you're interested in requesting training for your business, please complete the form below. Additionally, if you'd like to request naloxone kits for your restaurant, business, or yourself and you work in the industry, kindly fill out the form as well.

By completing this form, you can request both naloxone kits and/or training sessions for your team. If you do not need training, please indicate the number of naloxone kits you require. **1 box = 2 nasal sprays.

Check out if we're hosting any trainings through our event calendar here: https://www.intheweedsco.org/calendar 

Thank you for choosing In The Weeds. Your request enables us to better support your harm reduction needs. We'll be in touch shortly to assist you further.
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Full Name (First & Last) 
Restaurant/Business/Employer name Optional 
Phone Number
Email 
Type of request 
Have you been trained in how to safely administer Naloxone?
Clear selection
Would you like to request a training session on naloxone administration for your business/restaurant/staff?
Clear selection
Will you require Spanish interpretation? 
Clear selection
How many Naloxone Kits would you like? 1 kit = 2 nasal sprays. 
Where would you like us to drop off the Naloxone kits? Please provide the business name and/or location. 

If you prefer to pick up from our office, simply write 'Pick up', and we will coordinate a convenient time for you to collect the Naloxone kits from our location.
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