SWDH Partnerships for Success

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Please use this form to request substance use prevention and prescription drug safety materials. We will reach out within 7 business days of your request to confirm availability of materials and selected delivery method. Please note that all requests are subject to availability and we will do our best to accommodate. If you have any questions, please reach out directly to Tara Woodward at (208) 477-4998 or tara.woodward@phd3.idaho.gov.

Email *

Name *

Email *

Organization *

Phone number *

Which sector best describes your work? *

What county will these materials be used in? (Select all that apply) *

Adams

Canyon

Gem

Owyhee

Payette

Washington

Required

Preferred contact method *

Phone

Required

Items may picked up at SWDH Caldwell offices by appointment. Items may also be shipped or dropped off. Eligibility for shipping and drop-off determined by location. *

Pick-up at SWDH, please contact me when my items are ready

Please drop-off

Required

Delivery address for items to be shipped or dropped off (will be determined based on distance).

Please specify the quantity of Drug Deactivation Pouches - Small (15 pills/2oz liquid/2 patches) you would like to order.

Please specify the quantity of Drug Deactivation Pouches - Medium (45 pills/6 oz. liquid/6 patches) you would like to order.

Please specify the quantity of Drug Deactivation Pouches - Large (90 pills/12 oz. liquid/12 patches) you would like to order.

Please specify the quantity of small Prescription Medication Lockboxes (5" x 8") you would like to order.

Please specify the quantity of medium Prescription Medication Lockboxes (5.4" x 11.8") you would like to order.

Please specify the quantity style of Be the Parents coffee sleeves you would like to order.

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