EMPOWER Referral Form

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Referring service details





Contact details












If the exact date is unknown, please give your best estimate.
Your family








Client's family









Equality and diversity








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Please tell us as much as you can about your substance use.

Main substance details - please note EMPOWER is for clients whose primary substance is crack or heroin





Second substance details





Third substance details





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Based on current or previous substance use of snorting/injecting/sharing.










*If you would like details to call them yourself or for a friend, you can find more info on our website: www.oasisproject.org.uk, or call directly for a confidential talk on: 01273 675 526.

Based on current or previous substance use of snorting/injecting/sharing.

*If you're unsure about either health questions, you can access free screening via your local sexual health/gum (apt or walk in) clinics for East Sussex.








Consents