Safe Medication Storage Program

Thank you for participating in a brief survey for the Safe Medication Storage Program. With your input, we can get medication locking bags and prescription locking bottles into more people’s hands and help fight the opioid pandemic together. Your feedback is important and will help shape the future of the project.

Participation in the research is entirely voluntary and you can choose not to participate at any time, before or during the survey.

The survey will include questions about medication storage.

All of your responses to this survey will remain anonymous and will not be linked to you in any way. Survey responses will only be identified with a random number.

We appreciate your help making this program better. Please complete the form below to be included in this study and receive a notification in a couple of weeks in order to provide your feedback.

Name(Required)

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Preferred Method of Outreach(Required)

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Consent(Required)

I agree to participate in a future survey.

I freely agree to participate in a future survey for the Safe Storage Program. My participation is voluntary. The project has been satisfactorily explained to me, and all my questions have been answered.

Date(Required)

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