Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

NARCAN® Kit Request Form

  1. Please complete this form and one of our PORT team members will reach out to provide you with the requested kits. If you would prefer, kits are also available at the Rowan County Health Department Monday through Friday 8 a.m. to 5 p.m.
  2. Leave This Blank:

  3. This field is not part of the form submission.