Oasis Project Drug & Alcohol Treatment and Support Referral Form

Please use this form if you are over the age of 18 and would like advice, help or guidance concerning your drug or alcohol use. It’s the same form for the Hope Treatment Service.

This form will take around 5-10 minutes to complete

 

Please note this is not the referral form for Hope Therapy Services. To make a referral for therapy please use the following link Hope Therapy Services Referral Form

Referral route
Please choose 'no' if you are referring a friend or family member, or are a professional referring a client
Your Details (the person making the referral)







We can still accept a referral if the client has not yet consented; we will just need to discuss this with you
Your details












Details of the person you are referring (the client)











How can we make contact with you?

If it might be difficult for you to to answer the phone safely, please choose ‘no’ and provide some brief information at the end of the form.




How can we make contact with the client?

If it might be difficult to answer the phone safely, please choose ‘no’ and provide some brief information at the end of the form.




Referral Details

It is helpful if you include what you are drinking/using, how much you are drinking/ using and how often you are drinking/using.

e.g. mental health, social services or housing?
Referral Details

It is helpful if you include what they are drinking/using, how much they are drinking/ using and how often they are drinking/using.

e.g. mental health, social services or housing?
Your family






Client's family






Equality and diversity




Equality and diversity




Disability and health information


Disability and health information


Any other info

Your completed form will automatically be submitted to our team when you click submit – you do not need to do anything else – we will be in touch.

Any other info

Your completed form will automatically be submitted to our team when you click submit – you do not need to do anything else – we will be in touch.

Contact Information