Request a Harm Reduction Kit
Request a kit of harm reduction supplies to support your health and safety.
First Name
*
Name
First Name
Last Name
Location
South Bend
Austin
Elkhart
Request Date & Time
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Supply Request
Place a mark next to the supplies that you are requesting.
Select the supplies you are requesting:
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Categories:
All
All
Safer Drug Use
Safer Sex Tools
Health Supplies
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Safer Drug Use
Hammer Pipe Kit
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Glass Stem Kit
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Snorting Kit
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Needle Cleaning Kit
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Narcan
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Fentanyl Test Strips
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Xylazine Test Strips
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Benzo Diazepine Strips
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Small Sharps Container
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Safer Sex Tools
Male Condoms
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Non-Latex Male Condoms
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Female Condoms
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Dental Dams
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Lubricant
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Flavored Lubricant
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Health Supplies
General Hygiene Kit
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Female Menstrual Kit
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Wound Care Kit
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Socks
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Mylar Blanket
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Hand Warmers
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Nylon Bags
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Safer Drug Use
Hammer Pipe Kit
Glass Stem Kit
Snorting Kit
Needle Cleaning Kit
Narcan
Fentanyl Test Strips
Xylazine Test Strips
Benzo Diazepine Strips
Small Sharps Container
Safer Sex Tools
Male Condoms
Non-Latex Male Condoms
Female Condoms
Dental Dams
Lubricant
Flavored Lubricant
Health Supplies
General Hygiene Kit
Female Menstrual Kit
Wound Care Kit
Socks
Mylar Blanket
Hand Warmers
Nylon Bags
Submit
Should be Empty: