2025 Lock Box Request Form

Thank you for your interest in lethal means safety to help prevent suicide and self-harm in California. If you are interested in receiving free firearm/medication lock boxes from the CDPH Office of Suicide Prevention (OSP) for distribution in your community, please complete the request form below. OSP will then fulfill your request based on availability. Lock boxes will be available on a first-come, first-serve basis. The request form must be completed in its entirety to receive lock boxes. Incomplete responses cannot be processed.

1. Please provide your contact information:

First & Last Name *This question is required.

Title/Role *This question is required.

Organization Name *This question is required.

Email Address *This question is required. This question requires a valid email address.

Phone Number (Cell or Office) *This question is required.

2. What county (or counties) does your organization serve/represent? Please add any Tribal populations you are serving in this area. *This question is required.

3. Please select which of the following best describes your organization: *This question is required.

Please enter an 'other' value for this selection.