Use Naloxone to save a life Question Title * 1. I live in Ohio No- If you do not live in Ohio please contact your state's local health department. Yes Question Title * 2. Please provide your contact information. Name Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 3. I watched the video provided on the website Yes No Question Title * 4. What is your age? Under 18 18-24 25-34 35-44 45-54 55-64 65+ Question Title * 5. Which race/ethnicity best describes you? American Indian or Alaskan Native Asian / Pacific Islander Black or African American Hispanic White / Caucasian Other prefer not to say Question Title * 6. What is your gender? Male Female Prefer not to say Other (please specify) Question Title * 7. How helpful was the content presented at the event? Extremely helpful Very helpful Somewhat helpful Not so helpful Not at all helpful Question Title * 8. Would you like to receive additional information about Naloxone? Please provide how you would like to be contacted below. email phone Text No further questions Question Title * 9. Is this the first naloxone (Narcan) kit you have received? Yes No Question Title * 10. If no, what happened to the first kit? The kit was used on another person who was over dosing and they survived The kit was used on another person who was over dosing and they did not survive The kit was used on me. The medication kit expired Question Title * 11. What is the intended use for naloxone? If I overdose If a friend or family member overdoses If a friend or family member overdoses If I see someone overdose Done