Tickets & information about the Social Justice Conference – 18-20 September 2024 – are now live

Based on your answers, you may be experiencing moderate problems relating to your drug use. These problems could be affecting your health or future health and you may want to make some changes.

Our Advice

We suggest you get in touch with us so we can explore this together. There are a variety of ways you can do that using our online or telephone services, as well as coming in to see us if needed. We just need a little bit of information – Get some help and advice – refer today

Other things to access right now: to monitor your drug use and take a look at our to ensure safe use.

    SELF REFERRAL FORM

    What service location would you like to refer into? (Required)

    ABOUT YOU

    How should we contact you? Select all that apply (Required)

    PhoneTextEmailLetter

    Can we contact you at any time?

    YesNo

    Can we leave a voicemail?

    YesNo

    Gender (Required)

    Ethnicity (Required)

    HEALTH INFORMATION

    What do you need help with? Select all that apply (Required)

    Drug use supportAlcohol use supportFamily supportOther

    What substances do you use? Select all that apply (Required)

    Heroin/opiatesCocaineCrack cocaineCannabisCrystal meth/methamphetamineAmphetamine/speedAlcoholSolventsNew psychoactive substancesPrescribed medications (e.g. Benzodiazepine, Gapapentin)Other Please give details including how much and how often the substance is being used:

    If you have completed an alcohol or drug audit, what is your score?

    Do you have access support needs e.g. mobility or interpreter requirements?

    Are you pregnant?


    Are you currently injecting substances.

    YesNo
    Have you been admitted to hospital in the last month?

    YesNo

    Is there anything else you would like to tell us?

    Personal information is important to us and we will keep it confidential. Occasions where we may need to share information are outlined in our privacy and confidentiality policy. You can read our privacy policy here, or alternatively you can ask for a copy from us.

    Submit this form and we will contact you to arrange an appointment.

    Thank you for reaching out to Cranstoun.

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