Opioid Support Survey

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For medical, fire, or police emergencies, please call 9-1-1.

All information regarding your survey and information therein will be kept strictly confidential in accordance with federal law (42 CFR Part 2), meaning your personal details and requests cannot be disclosed without your written consent, except in limited emergency situations.
Do you have a working phone?
Your phone number will not be shared outside the Chandler Fire Department, and you will not be contacted unless we have questions to clarify information.
Are you a resident of Chandler, AZ?
Zip Code
Are you willing to take a brief self-assessment survey?
Is assistance needed because you use opiates (such as heroin, morphine, codeine, vicodin, oxycontin and/or fentanyl)?
Is non-emergency support needed because someone in your home, family member or friend you know using opiates?

Opiates are drug like heroin, morphine, codeine, vicodin, oxycontin and/or fentanyl
Are you willing to administer Narcan?

Remove the cap on the Narcan nasal spray and insert the nozzle into one of the person's nostrils. Press the plunger firmly to release the dose of naloxone (another drug name for Narcan).
I have opioid related issues in my life that I need to work on.
Everyone else is the problem, not me.
There's really nothing I need to change about my opiate use or how I'm living my life.
I have opiate related issues in my life that I need to work on.
I think it's time to do things differently.
I'm not sure I am ready to do things differently in my life.
Would you like to pick-up the Narcan by appointment or have it dropped off (to you in person).
The Narcan kit is for:

To provide free Narcan we must have the Chandler Zip Code where it was distributed.
(Gate code, information about drop off location, etc)
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