NMHRC inc. Order Request
**PLEASE READ BEFORE PLACING YOUR ORDER**

NM Harm Reduction Collaborative is a 501(c)3 Non-Profit offering on demand delivery and pick-up of Harm Reduction Supplies and Overdose Prevention items such as Naloxone. We are required to collect some data at the time of your order per the NMSA 1978 24-2C Harm Reduction Act. In accordance with HB52 we are now able to provide Fentanyl Test Strips and Reagents. 

NMHRC ONLY OFFERS DELIVERY IN ALBUQUERQUE - IF YOU ARE OUT OF TOWN WE CAN OFFER DELIVERY VIA MAIL SOMETIMES DEPENDING ON FUNDING AT THAT MOMENT. 

*ORDERS PLACED AFTER 4 WILL BE RESOLVED THE FOLLOWING DAY**

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By clicking "I agree", you are agreeing to follow the scheduling and ordering instructions in this form, and are therefore acknowledging that you are being given access to all services NMHRC offers such as harm reduction supply delivery, overdose prevention education and Naloxone distribution, substance use education and education on substances in general, as well as any referral to legal aid or other resources.  *
NMHRC will always keep your information confidential and protected. 
Welcome to the New Mexico Harm Reduction Collaborative Online Order form! Please read and fill out.
Your full name and pronouns if applicable *
A good Phone Number for you (let us know if its a text now!) *
Address we will be meeting you at *
SHARPS CODE: This is required by law in order to receive Harm Reduction services.
Your code is: The first 2 letters of your first name, the first 2 letters of your mothers first name, and the year you were born.
Example: ASKR88

PLEASE ENTER YOUR SHARPS CODE BELOW
*
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What type of place will we be meeting you? (This is confidential, we do not share this info with anyone outside of our organization) *
Do you have any special circumstances you want us to know about? (Pregnant, COVID symptoms, abscess you want us to look at, etc) *
Do you need Fentanyl Test Strips? If so, how many? (max of 5 per person)
How many people need supplies there? Please have each person fill out a separate form or text the NMHRC phone number to give us info on the situation. **more than 5 people = text us to let us know asap** *
Choose your Syringe Size(s) - if choosing more than one size please indicate how many of each you want when the quantity question comes up. 
How Many Syringes Do you need? 
(NOTE: we are not an exchange. This means you do not have to give us syringes in order to get syringes! We just give you as many as you need)
How many syringes are you returning? (Estimates are okay!) *
What size sharps contain do you need? *
Do you need Injection Alternatives?

** Glassware is limited to *ONE* per person due to high demand and high cost of items. Foil is not limited at all, please let us know how much foil you need in the next question. 
Foil Kits come in two sizes:
- Small 4''x4'' Uncoated Foil Sheets
- Large 8''x12'' Uncoated Foil Sheets

Please let us know which one you would like
*
Required
How Many of each Foil Size would you like? *
Do you need Wound Care Supplies?
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All orders come with enough works for one person (2 ties, cottons, alcohol pads, cookers, and twist ties) Do you need any additional works?
Additional Supplies to Choose From
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