BCHD CRRS Community Request Form

BCHD Community Risk Reduction Services: Community Request Form
Please complete this form to request services from Baltimore City Health Department Community Risk Reduction Services. Services offered include (but are not limited to): informational sessions on harm reduction vending machines and sharps disposal drop boxes, harm reduction 101 training, basic naloxone overview, tabling at community events, or requests for harm reduction supplies.

PLEASE NOTE: submitting a request does not guarantee service delivery. We will try to accommodate all requests, but may be limited by our inventory or schedule conflicts.

If you have any questions, reach out to CommunityRiskReductionServices@baltimorecity.gov
Please complete the questions below with your information.
Point of contact first & last name

First NameLast Name
Point of contact email
example@example.com
Point of contact phone number
Please enter a valid phone number.Format: (000) 000-0000.
If you're reaching out on behalf of an organization or agency, please name it below. If you're not, put N/A.
What type of organization or agency are you from?

Other
Complete the questions below with details about the services you're requesting.
What services are you requesting? Choose all that apply.

Other
If you're requesting harm reduction supplies, please list what you'd like and the quantity. Please note: requesting supplies does not guarantee its availability.
If you're requesting an info session, training or attendance at an event, please list possible dates and times below in MM/DD/YY HH:MM-HH:MM format. (ex: 5/20/26 10:00am-12:00pm)
If you're requesting attendance at an event, please list the expected setup, start, end and breakdown time. (ex: 1 hour to setup, event starts at 10:00am and ends at 2:00pm, 1 hour to breakdown)
If you're requesting an info session, training or attendance at an event, what format will it be?
If you're requesting an IN-PERSON info session, training or attendance at an event, list the address below.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If you're requesting an in-person event, would like us to bring harm reduction supplies like naloxone and drug testing strips?
If you're requesting an in-person event, will your organization provide table and chairs?
Is there anything else we should know?
Should be Empty:

BCHD Community Risk Reduction Services: Community Request Form

Please complete the questions below with your information.

Complete the questions below with details about the services you're requesting.