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

Based on your answers, you may be experiencing major problems relating to your drug use. These problems are likely to be affecting your physical and mental health, relationships, money and housing as well as possibly damaging your future health. We encourage you to take that next step and get in touch with us so we can support you to make positive changes for a healthy, safe and happy life.

Our Advice

Please get in touch – whether through our online or telephone services, or coming in to see us. We will be able to give specific advice and support in a way that is right for you.

We just need a little bit of information – please complete the online referral form below to get things moving.

If you would prefer to see your GP instead, make an appointment with them and let them know about your results (GPs will know it as a drug screening tool called DAST-10).

Other things to access right now: Take a look at the information on our webpages 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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