You've reached this page because you're interested in receiving harm reduction supplies through NEXT Distribution.

The following information is kept for statistics purposes and helps describe what we do and who we provide supplies to.  

 
How do you want us to communicate with you about supply ordering? *
Please describe your race or ethnicity *
This helps us describe who we provide services to.
In the past 30 days did you use *
We know that sometimes people don't have access to new, sterile syringes or other injeciton equipment. In the past three months have had to share any of the following:
What is your current health insurance status? *
For example: HealthFirst, MetroPlus, Affinity, BCBS, Emblem, VNS, etc.
Name *
Name

NYS Syringe Exchange Program ID

Date of Birth
Date of Birth

The following questions are also required for program enrollment

Name *
Name
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Date
Date
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