HHC Narcan Request Form for Cortland County

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Fill out as much of the form as you are able and based on your needs, a local volunteer will reach out to get you a kit of Narcan or other support. This is not for emergency Narcan requests but we are typically able to get you a kit within 24 hours. See bottom for other resources. In case of emergency, call 911.

Name *

Give us your e-mail address and/or phone number:

Contact Information *

Give us your e-mail address and/or phone number:

Tell us what you are looking for (select all that apply): *

I need Narcan ASAP - we can typically get you a kit within 24 hours

I would like to get Narcan sometime in the near future (not urgent)

Other:

Required

For more urgent requests, see list of resources at the bottom.

What is your main reason for requesting a Narcan kit today?
*

To replace a kit that I used to reverse an overdose

To replace a kit that was lost or stolen

To replace a kit that has expired (remember, expired Narcan is still better than no Narcan)

This is my first kit, and I want to be able to respond if someone I know overdoses

this is my first kit, and I want to be able to respond if someone I don't know overdoses

Other:

Any additional information you would like to provide:

Thank you for filling out this form. A HHC volunteer will reach out to you within 24 hours. For more information about local resources, visit healingcortland.org/narcan.

If you are in urgent need, reach out and someone will work with you to get you a Narcan kit:

During regular business hours M-F 9-5pm (except holidays), call/text STAP’s Cortland Mobile Team: Call (607)725-6335 or (607)725-6847 OR call/text (607)882-4858
After hours and weekends, call/text Dean of Healing Hearts Collaborative at (607)283-6378.
There are also 3 emergency-use Narcan Mailboxes at the following locations: 1) on the side of the Wishing Wellness Center 24 Church St, Cortland, NY 13045(outside), 2) inside office at the Econo Lodge10 Church St., and 3) Hair Studio 90 at 2 Union St, Cortland next to Daily Grind South.

If this is an emergency, call 911.

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