---
title: Overdose Prevention & Harm Reduction Services Enrollment Form Template | Paperform
description: Confidential enrollment form for harm reduction programs offering naloxone distribution, syringe exchange, HIV/Hep C testing, and substance use treatment referrals. Low-barrier, trauma-informed design.
url: "https://paperform.co/templates/overdose-prevention-harm-reduction-services-enrollment"
type: static
generatedAt: "2026-03-28T00:44:42.539Z"
---

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### Accessible Overdose Prevention Services for Your Community

Harm reduction saves lives. This **Overdose Prevention & Harm Reduction Services Enrollment Form** provides a dignified, confidential pathway for individuals to access life-saving resources including naloxone distribution, syringe exchange programs, HIV and Hepatitis C testing, peer support, and connections to substance use treatment when they're ready.

Built with Paperform, this template is designed for public health departments, community health organizations, mobile outreach teams, and nonprofit harm reduction programs that prioritize meeting people where they are—without judgment, barriers, or prerequisites.

#### Why Paperform for Harm Reduction & Public Assistance Programs

Paperform gives public health teams and community organizations a secure, accessible platform to deliver services that respect privacy and reduce barriers to care. Unlike generic survey tools, Paperform combines thoughtful form design with workflow automation to help your team focus on what matters: getting resources into the hands of people who need them.

**Key benefits for harm reduction programs:**

 - **Confidential by design:** Collect only what's necessary, with optional demographic fields that respect participant autonomy. SOC 2 Type II compliance and data residency controls ensure information stays protected.
 - **Mobile-first accessibility:** Participants can enroll on any device, whether they're accessing services at a fixed site, through mobile outreach, or from home.
 - **Conditional logic for personalized pathways:** Show relevant service options based on participant needs—naloxone training, safer injection supplies, testing services, or treatment referrals—without overwhelming people with irrelevant questions.
 - **Instant resource delivery:** Use custom success pages and email notifications to immediately provide participants with locations, hours, what to bring, and next steps.
 - **Automated follow-up workflows:** Connect to Stepper (stepper.io) to schedule follow-up texts, coordinate testing appointments, trigger peer support check-ins, or route referrals to treatment providers without manual data entry.

#### What This Template Includes

This enrollment form walks participants through:

 1. **Welcome and confidentiality statement** explaining services, privacy protections, and voluntary participation
 1. **Contact preferences** allowing participants to choose how and when to be reached
 1. **Service selection** covering naloxone/Narcan, syringe exchange, HIV/Hep C testing, wound care, peer support, and treatment referrals
 1. **Harm reduction education preferences** for overdose response, safer use practices, fentanyl test strips, and Xylazine awareness
 1. **Health screening questions** (optional) to help staff prepare appropriate resources
 1. **Demographics and insurance** (optional) for program reporting and billing without creating barriers
 1. **Consent for services** with clear language about what participants are agreeing to

All questions prioritize participant agency, with many marked optional to reduce barriers while still gathering data needed for program evaluation and funding compliance.

#### Designed for Real-World Harm Reduction Settings

Whether you're running a fixed-site syringe services program, a mobile naloxone distribution unit, or a drop-in center offering comprehensive support, this template adapts to your service model:

 - **Street outreach teams** can complete forms on tablets in real-time, even with limited connectivity
 - **Drop-in centers** can offer kiosks or staff-assisted enrollment for participants with varying digital literacy
 - **Referral partners** can embed the form on their websites to help people pre-register before visiting
 - **Public health departments** can use conditional logic to route enrollments to the right program sites based on zip code or service needs

#### Automate What Comes After Enrollment

Paperform's integration ecosystem means enrollment doesn't end at "Submit." Connect your harm reduction program to the tools you already use:

 - **Send rosters to case management systems** via webhooks or Airtable to track participant engagement over time
 - **Trigger appointment reminders via SMS** for testing or follow-up visits using Stepper workflows
 - **Route treatment referrals** directly to partner providers with relevant intake information pre-populated
 - **Update dashboards in real-time** by pushing enrollment data to Google Sheets or Power BI for grant reporting
 - **Notify mobile teams** via Slack or email when someone requests same-day services

With Stepper's AI-native workflow builder, you can create sophisticated follow-up sequences—like sending Narcan refill reminders after 30 days, checking in after a first testing appointment, or escalating urgent referrals—all triggered automatically from form submissions.

#### Built for the Industries and Roles That Do This Work

This template is designed specifically for:

**Industries:**

 - Public health departments and local health agencies
 - Community health centers and FQHCs
 - Harm reduction and syringe services programs
 - Substance use treatment providers
 - HIV/AIDS service organizations
 - Homeless services and street outreach programs
 - Peer support and recovery community organizations

**Roles:**

 - Harm reduction coordinators and outreach workers
 - Public health nurses and case managers
 - Peer support specialists and navigators
 - Program directors at nonprofits
 - Community health workers
 - Social workers and crisis responders
 - Grant administrators and program evaluators

#### Low-Barrier Access Meets High-Quality Data

One of the biggest challenges in harm reduction work is balancing the need for low-barrier services with the data requirements of funders, health departments, and evaluation partners. This template threads that needle by:

 - Making core service requests simple and fast
 - Marking demographic and clinical questions as optional
 - Using friendly, non-stigmatizing language throughout
 - Providing "prefer not to answer" options where appropriate
 - Collecting consent clearly and separately for different uses (services, follow-up, data sharing)

Participants can get what they need without feeling interrogated, while your program still captures the information needed to demonstrate impact, maintain compliance, and secure future funding.

#### Accessible, Inclusive, and Trauma-Informed

Paperform's flexible design options let you create forms that reflect trauma-informed, culturally responsive best practices:

 - Choose fonts and colors that are easy to read and reduce cognitive load
 - Add images, icons, or videos to support participants with varying literacy levels
 - Use Guided Mode for a gentler, one-question-at-a-time experience
 - Embed the form in multiple languages or create separate versions for different communities
 - Remove branding or clinical aesthetics that might feel institutional or unwelcoming

Every element can be customized to meet your participants where they are, honoring their dignity and autonomy throughout the enrollment process.

#### Get Started in Minutes, Not Months

Unlike building a custom intake system from scratch or trying to adapt EHR platforms not designed for harm reduction, this Paperform template is ready to use today. Customize the service options, add your program's logo and contact information, adjust conditional logic for your specific workflow, and you're ready to start enrolling participants.

Trusted by health departments and nonprofits worldwide, Paperform combines ease of use with enterprise-grade security—SOC 2 Type II certified, GDPR compliant, and built to protect the privacy of vulnerable populations.

**Harm reduction works. This template helps you do more of it, with less administrative burden and more time for the human connections that save lives.**
       Built for growing businesses, trusted by bigger ones.   Trusted by 500K+ business owners and creators, and hundreds of millions of respondents.     ![Capterra - 4.8 out of 5](/images/capterra-st.jpg)
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