Safe.Med.Drop

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Safe.Med.Drop

Thank you for your interest Safe Med Drop!

1. What's the name for the pickup? (First and Last)

2. Phone Number/Email (For confirmation and updates)

3. What's the address for the pickup?

Please enter your full address on one line in this order:

Street Number and Street Name, Apartment or Unit (if applicable), City, State, ZIP Code.

Ex: 5678 Pine Avenue Apt 5B, Chicago, IL 60614

4. Approximate number of items being sent for pickup?

1-5

6-15

16+

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5. Types of Medications? (check all that apply)

Antibiotics

Prescription Medications

Over-the-counter medications

Pet medications

Liquids (sealed in a Ziploc/Airtight bag

6. Safety Screening *

I confirm these items DO NOT INCLUDE needles, sharps, inhalers, aerosol cans, or medical waste

I understand liquids must be sealed in a Ziploc/Airtight bag

Required

7. Consent and Acknowledgement *

I consent to Safe.Med.Drop collecting and safely disposing of these medications

I understand medications will not be returned

I acknowledge this service is for disposal only, not medical advice

Required

Submit

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