Naloxone(Narcan) Order Form Date of Request Have you downloaded & reviewed the Narcan Training Material? YesNo - https://www.youtube.com/watch?v=KEOq6fUWNtA Please Upload Acknowledgement of Narcan Training Maximum filesize: 50 MB. Allowed extensions: txt, doc, rtf, pdf, jpg, jpeg, png, zip, gz, bz, bz2. View Acknowledgement of Narcan Training Form Contact Name* Date of Birth Phone Number* Address* Email* Gender* MaleFemaleUndisclosed Ethnicity/Race African American/BlackAsianCaucasianHispanic/LatinoOther Reason for Request Select NARCAN Pickup Location Apple Valley Clinic: 18818 US Highway 18, Apple ValleyMariposa Community Counseling Clinic: 2940 Inland Empire Blvd., OntarioRialto Behavioral Addiction Treatment Services: 850 E. Foothill Blvd., RialtoBarstow Behavioral Health: 1841 E. Main St. Ste. 218, BarstowPhoenix Community Counseling Center: 820 E Gilbert St. San BernardinoAmazing Place Clubhouse, 2940 Inland Empire Blvd., OntarioPathways to Recovery Clubhouse, 17053 E. Foothill Blvd., Ste. B, FontanaDesert Stars Clubhouse, 1841 E. Main St., BarstowSerenity Clubhouse, 12625 Hesperia Rd., Ste. B, VictorvilleTEAM House Clubhouse, 201 W. Mill St., San BernardinoAdelanto Health Center, 11336 Bartlett Ave. Ste. 11, AdelantoHesperia Health Center, 16453 Bear Valley Rd., HesperiaOntario Health Center, 150 E. Holt Blvd., 2nd Floor, OntarioSan Bernardino Health Center, 606 E. Mill St., 1st Floor, San BernardinoNeedles Health Center, 1406 Bailey Ave., Ste. D, Needles (open Monday-Thursday 7 a.m. - 5 pm.)