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2. Self Referral

3. 

5. The Wyoming County Public Health Prevention Center offers Naloxone training right at your facility. The training will cover:

   • Signs and symptoms of an opioid overdose
   • Good Samaritan Law
   • Use of Narcan (Naloxone) to reverse an overdose
   • Reporting and follow up

   This training takes approximately 30 minutes. 

   Please complete the information below. Someone from the Wyoming County Public Health Department's Prevention Center will reach out to you by the next business day to set up a training.  

9. Name
10. Email Address
12. Address
14. City
15. State
16. Zip Code
18. Phone Number
19. Fax Number
21. Name of Organization
22. Number of Employee's Being Trained
24. Do you need to exchange an expired naloxone?
    -- Select One --YesNo
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

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