DART Overdose Report

If this is a life threatening Emergency or crisis, please call 9-1-1.

This form is to be used to Report an Overdose to DART, Drug Addiction Recovery Team. A Community Responder will reach out to the person being referred within 72 hours.

You may also reach us by telephone or text at 413-588-2335.
To Continue, please complete form below and Submit.

Referred By

All submitter's information is confidential and is not shared with any parties. If you are not the Person being Referred, to followup or if you have questions, you will need to contact us by telephone at 413-588-2335.

Referred By (if not Self) (required)

Referred By First

Referred By Last

Referred By Cell Phone

Referred By Email

Person Being Referred

First Name

Last Name (required)

Alias

Street Address

Unit/Suite

City

State

Zip Code

Home Phone (required)

Date of Birth

Gender

Gender Other

English Speaking

Primary Language

If Other language

Race

If Other Race

Hispanic/Latino/a

Pronouns

Other Pronoun

Veteran Status

Currently Houseless