Self Referral Form

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Are you concerned about your own or another's use of alcohol and/or other drugs? Do you think you need help or do you just want to talk to someone about your situation?

We know that making contact with alcohol and drug services is a big step and takes courage. But there's nothing to be afraid or ashamed of - we welcome everyone and will listen to your concerns and problems. 

Connect with us and we will work together with you to find a solution that is tailored to you individual situation. 

Just fill out the form on the left and we will be in contact with you as soon as possible - usually within 72 hours.

If you would like to talk directly with someone, you can call or visit one of our services.

Please note: Our services are only available via phone during usual business hours on weekdays.

If this is an emergency and you need help immediately, please call the Alcohol Drug Helpline on 0800 787 797.