Are you making this referral for yourself or someone else?(Required) Do you currently feel safe? We're asking this question so we know in advance if you might need extra safeguards when you come to us for support.
Are you a professional or a friend/family member/concerned other(Required) Is the person you are referring aware of the referral?(Required) Thank you for starting this referral. Unfortunately, we are unable to continue at this stage as the person you are referring is not currently aware of the referral. To move forward, please talk to the person about this referral and make sure they agree to be referred. Once they are aware, you are welcome to restart the referral process.
If you have any questions or need support in having this conversation, we’re here to help. Please contact Barnsley Recovery Steps on the following number: 01226 779066.
Thank you for starting this referral. Unfortunately, we are unable to continue at this stage as the person you are referring is not currently aware of the referral. To move forward, please talk to the person about this referral and make sure they agree to be referred. Once they are aware, you are welcome to restart the referral process.
If you have any questions or need support in having this conversation, we’re here to help. Please contact Calderdale Recovery Steps on the following number:
01422 415550.
Thank you for starting this referral. Unfortunately, we are unable to continue at this stage as the person you are referring is not currently aware of the referral. To move forward, please talk to the person about this referral and make sure they agree to be referred. Once they are aware, you are welcome to restart the referral process.
If you have any questions or need support in having this conversation, we’re here to help. Please contact Forward Leeds on the following number:
0113 887 2477.
Thank you for starting this referral. Unfortunately, we are unable to continue at this stage as the person you are referring is not currently aware of the referral. To move forward, please talk to the person about this referral and make sure they agree to be referred. Once they are aware, you are welcome to restart the referral process.
If you have any questions or need support in having this conversation, we’re here to help. Please contact Lewisham Primary Recovery Care Service on the following number:
020 8699 5263.
Thank you for starting this referral. Unfortunately, we are unable to continue at this stage as the person you are referring is not currently aware of the referral. To move forward, please talk to the person about this referral and make sure they agree to be referred. Once they are aware, you are welcome to restart the referral process.
If you have any questions or need support in having this conversation, we’re here to help. Please contact Likewise Sheffield on the following number: 0114 308 7000.
Thank you for starting this referral. Unfortunately, we are unable to continue at this stage as the person you are referring is not currently aware of the referral. To move forward, please talk to the person about this referral and make sure they agree to be referred. Once they are aware, you are welcome to restart the referral process.
If you have any questions or need support in having this conversation, we’re here to help. Please contact New Vision Bradford on the following number: 01274 296023.
Thank you for starting this referral. Unfortunately, we are unable to continue at this stage as the person you are referring is not currently aware of the referral. To move forward, please talk to the person about this referral and make sure they agree to be referred. Once they are aware, you are welcome to restart the referral process.
If you have any questions or need support in having this conversation, we’re here to help. Please contact North Yorkshire Horizons on the following number: 08000 14 14 80.
Thank you for starting this referral. Unfortunately, we are unable to continue at this stage as the person you are referring is not currently aware of the referral. To move forward, please talk to the person about this referral and make sure they agree to be referred. Once they are aware, you are welcome to restart the referral process.
If you have any questions or need support in having this conversation, we’re here to help. Please contact Recovery Steps Cumbria on the following number: 01900 512300.
Thank you for starting this referral. Unfortunately, we are unable to continue at this stage as the person you are referring is not currently aware of the referral. To move forward, please talk to the person about this referral and make sure they agree to be referred. Once they are aware, you are welcome to restart the referral process.
If you have any questions or need support in having this conversation, we’re here to help. Please contact South Tyneside Adult Recovery Service on the following number: 0191 917 1160.
Name of the person being referred(Required)
First
Middle
Last
Date of birth of person being referred(Required) Gender at birth of person being referred(Required) We are asking this so we can tailor support to the person's individual situation.
Gender identity We are asking this so we can tailor support to the person's individual situation.
Do you have a fixed abode/address?(Required) Does the person being referred have a fixed abode/address?(Required) What type of address is this?(Required) What type of address is this?(Required) Address(Required)
Address of the person being referred(Required)
Please select all the methods you're happy for us to contact you through(Required) Please provide some details about the substance use frequency and amount used(Required)
We ask this so we know what type of support we should be offering you.
What are your goals for support and/or treatment?(Required)
We ask this as everybody's goals are different and we can tailor support to what you want to achieve.
Do you have any communication needs?(Required) We ask for this information so that we know how best we can communicate with you and if any extra assistance will be required.
Does the person have any communication needs? We ask for this information so that we know how best we can communicate with the person being referred and if any extra assistance will be required.
Please tell us what communication needs you have(Required) We will use this information to ensure our support considers how best we can communicate with you.
Please tell us what communication needs they have We will use this information to ensure our support considers how best we can communicate with them.
Do you have any physical health or accessibility needs you would like us to consider?
We ask this question so that we can assess how best we can support any extra health needs you might have.
Do you have any mental health needs you would like us to consider?
We ask this question so that we can assess how best we can support any extra health needs you might have.
Is there any other relevant information you would like to tell us about the person you are referring?
Is there any other relevant information you would like to tell us about yourself?
Please read the following privacy script and let us know when you've done so by checking the correct option. If you are referring someone else, this must have been read to them and understood.(Required) This project is part of a charity called Waythrough.
Our top priorities are your safety and helping you achieve your goals with us. To do this, we need to keep some information like your basic contact details and more sensitive information like your health details. This is called a “legitimate interest” to use your information.
We keep your information safe and only share it with others if there is a good reason. Most of the time we ask your consent before we share, and we will complete our consent process with you during your first appointments with us. Occasionally, we may need to share your information without seeking your consent if we are worried that you or someone else could be in danger. This is called safeguarding and is a UK law that all health and social care organisations must follow. We will usually be able to tell you what we have shared and to whom. We will provide a factsheet with examples when we meet.
Referrer name(Required)
First
Last
