Rapid REVIVE Narcan Training Request Form

RAPID REVIVE Narcan Training Request

Please fill out this form if you are interested in the RAPID REVIVE Narcan Training. This training is a short 30-minute presentation on the use of Narcan and how to identify and respond to an overdose. Upon completing the training, you will receive your own package of Narcan nasal spray (2 doses). We offer Rapid REVIVE! trainings at each of our county health departments from 12-2pm. Monday-Appomattox, Tuesday-Campbell, Wednesday-Bedford, Thursday-Lynchburg & Amherst. You can stop by any time during that period to receive the training. If you are not able to attend any of those scheduled trainings, you can fill out this form. *Please note that this is a request form for a training to receive Narcan. If you are looking for a speaker on substance use, please email AskCVHD@vdh.virginia.gov.
Requestor's Name

First NameLast Name
Organization Name (if applicable)
E-mail
example@example.com
Phone Number
Please enter a valid phone number.
Preferred Location for Training

Amherst County Health Department (224 2nd St. Amherst)Appomattox County Health Department (475 Court St. Appomattox)Bedford County Health Department (600 Bedford Ave. Bedford)Campbell County Health Department (116 Kabler Ln. Rustburg)Other (If you would like us to come to your business or organization to provide Rapid REVIVE! training, please include business/organization name and address)
City/County of Training
Number of Individuals Requesting Narcan Training
Requested Date for Training

MonthDayYear
Date
Additional Information/Comments
Should be Empty:

RAPID REVIVE Narcan Training Request