For a Client | Care NZ

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Referral for a Client

If you are working with someone who ís struggling with alcohol or other drug use, you can complete the form below on their behalf. Once received, our team will reach out with care and respect to provide the support they need, while working alongside you in their journey toward wellbeing.

To connect with any of our community counselling services call us on 0800 499 469

Referrer name

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Referrer organisation

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Referrer Contact Details

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Does the client consent to the referral?

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A summary of the reason for the referral

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Attach any relevant documents (eg. Assessments, risk management plan, treatment plan)

Up to 10 image or document files (5MB limit per file)

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Client Name

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Client Date of Birth

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Client Address

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Client Region

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Client Contact Details

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Address

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Are you worried about your own or a loved one's use of alcohol or other drugs?

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If you are keen to see if there is a community service in your area check our community service locations here or contact us on 0800 499 469