Please complete the application below. Applications do not need to be completed in one session. Please reach out to naloxone@utah.gov with any questions or concerns.

Thank you!

Page 1 of 6

Loading... Loading...
You have selected an option that triggers this survey to end right now.
To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.