Naloxone Usage Reporting Form

This form helps us understand how the naloxone we provide is being used in our community. All responses are completely anonymous. 

* Required Fields

In addition to requesting a replacement kit from GO Health, you can use the Text-for-Naloxone line. To get a free naloxone kit, text KIT to 877-535-2461 to have naloxone mailed to the address you provide.  

Naloxone is also available for pickup today at all pharmacies in New York State without a prescription. If you have prescription coverage through your health insurance, the Naloxone Copay Assistance Program will cover your copay up to $40. No enrollment is needed.

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