Skip to main content

Community partners are to complete and submit this form to order Naloxone kits or refills. Please note that it can take approximately 15 days after your organization submits an order to receive kits. The Chatham-Kent Public Health Unit will contact you regarding pick-up and/or delivery once the order is received and ready.

If you require a rush order due to unforeseen circumstances, please detail the circumstances in the “Additional Comments” section.

Upon submission, a copy of this form will be sent to the email address specified on the form.

Organization Information
Contact Information
Naloxone Information
Additional Comments

Please provide any additional information that you feel is pertinent for the ministry to know about, including: Information about any drug trends in your community, a need for naloxone in your community that is not being filled, and/or successes and challenges of your naloxone distribution program.