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2. Congratulations!

   You've taken the first step to changing you or a loved one's life. If you or a loved one has recently experienced a non-fatal overdose, submit this form and someone from the Craven County Opioid Epidemic Response will contact you to offer the help and resources you deserve. The Craven County Opioid Epidemic Response agrees to hold all information in strict trust and confidence and will use such information only for the purpose of assisting and attaining resources. 

   We help clients: 

   • Navigate to appropriate services (e.g., primary care, detox, treatment, etc.)

   • Accessing Medication Assisted Treatment (MAT) (e.g., methadone, suboxone, SAIOP, etc.)

   • Overdose prevention education

   The Craven County Opioid Epidemic Response does not provide long-term case management services.  However, we will support clients in accessing long term supports as needed.

   
   
6. First Name*
7. Last Name*
8. Suffix
   -- Select One --Sr.Jr.IIIIV
10. Email Address
11. Phone Number*
13. Address
15. City
16. State
17. Zip Code
19. Requested Needs

    1. Detox/Treatment Services
    2. Recovery Support Services (i.e. Peer Support)
    3. Food
    4. Transportation
    5. Health Care
    6. Housing

    1. Information on Syringe Exchange Services
    2. Naloxone/Narcan
    3. Harm Reduction (i.e. Drug Sample Testing Strips, HIV/Hepatitis B Testing)
    4. Employment Related Services
    5. Other
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit Submit and Print

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