translate Translate
Alert
Level 1 (Be Ready) Evacuation Notice for Areas in the Mount Hood Corridor READ MORE
click to return to home page

Public Health

Project Hope Referral Request

Project Hope Referral Request

Project hope handsSupport for overdose survivors and those navigating the road to recovery.

Indicates required field

Referral Information

Information for Person Making Referral

Organization

Additional Information

Is the referral homeless?

Are you interested in getting help to cut down or quit using drugs?

Will you go into withdrawal if you stop using?

Are you currently at-risk for overdose?

Do you have a history of drug overdose?
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

In addition to completing this referral form, if you are an EMS agency providing Buprenorphine, please text or call one the Community Paramedics to coordinate follow-up care.

Logos of Clackamas Fire District #1, MHAO, and Clackamas County H3S