Score: 3-5

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.

When we receive your referral form, our service will be in touch to complete an assessment with you.

If you are from an agency, we may require further information and will send you a further area-specific form to complete.

Full name (of person needing support) (Required)

Date of birth (Required)

Email address (Required)

Telephone (Required)

Mobile

Address

Postcode

Organisation & name of person referring client (If applicable)

Organisation email address (If applicable)

If you are contacting us on behalf of someone else please tick to confirm you have their consent to contact us.
YesNoN/A

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

How can we contact you (Required)
EmailTelephone

How can we help? Please provide as much detail as possible. (Required)

We will respond to your enquiry as soon as we can. If you are in danger, or there is a risk to life, please call the emergency services.

Score: 3-5

Our Advice

Sign up to our newsletter