ASAP of Dodge County

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Prescription Drug Deactivation Kit

Any Dodge County resident interested in receiving a prescription drug deactivation kit, to properly dispose of medication, should fill out the form below. Kit will be mailed, along with information on proper disposal. 

Please correct the field(s) marked in red below:

1
NAME: 
 *
NAME:
2
ADDRESS
 *
ADDRESS
3
PHONE NUMBER
4
EMAIL
 *
5
How many kits?
How many kits?
6
Would you like to be on our email distribution list (event notifications)
Would you like to be on our email distribution list (event notifications)
  1. To receive a copy of your submission, please fill out your email address below and submit.