Required fields are marked with asterisks (*)

Naloxone Kit Order Form for Registered Sites

Registered Sites Only

Check to see if you’re eligible by filling out the Naloxone Distribution Eligibility Form link found here.

PLEASE RETURN EXPIRED NALOXONE KITS TO YOUR LOCAL PHARMACY

The Haliburton Kawartha Pine Ridge District Health Unit will email you when your order is ready.

Pick up at your local HKPR Health Unit office:

Port Hope Health Unit Office - 200 Rose Glenn Road, Port Hope, ON L1A 3V5
Monday – Friday 8:30-4:30

Lindsay Health Unit Office - 108 Angeline Street North, Lindsay, ON K9V 3L5
Monday – Friday 8:30-4:30

Haliburton Health Unit Office - 191 Highland Street, Unit 301, Haliburton, ON K0M 1S0
Monday-Friday 8:30-4:30 but closed to the public daily from 10-10:15am, 1-2pm and 3-3:15pm

Contact Information

Agency Name:

First Name:

Last Name:

Phone:

Email:

Current Inventory

Current number of Naloxone kits in stock:

Current number of Naloxone refills in stock:

Typical Order Size

Assembled Kits:

I do not need any at this time

New sites: 10 kits

New sites: 20 kits

Small Site: 50 kits

Large Site: 100 kits

Refills:

I do not need any at this time

New sites: 5 boxes

Small Sites: 10 boxes

Large Sites: 25 boxes

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