Professional Referral

If you’re a professional helping someone with drug or alcohol use, you can refer them to us.
To do this, please complete a third-party referral form and send it to our secure inbox. The form includes all the details you need, including where to send it.Remember, you’ll need to get the person’s consent before making a referral.

If you need to discuss a client you’re supporting or want to know more about the range of services we provide please get in touch on 01246 206514 or email info@derbyshirerecoverypartnership.co.uk

Referrer Full Name: (required)

Role/organisation (required)

Referrer Telephone Number (required)

Referrer Email Address (required)

I confirm that the person being referred has given their consent for the referral and understands that their personal information and contact details will be shared with Derbyshire Recovery Partnership (required)

Yes

I confirm that the person being referred has given their consent for the information I provide to be recorded on their NHS record (required)

Yes

I confirm that the person being referred has consented to be contacted by Derbyshire Recovery Partnership using the contact details provided (required)

Yes

Client's full name (required)

Client's date of birth (required)

Client's NHS number, if known

Client's full address including postcode (required)

Client's contact telephone number (required)

Are children's social care involved?

Yes

Problem Substance (required)

If yes, detail any additional information regarding risk here:

Additional referral information

I agree to the privacy policy

The above form will be submitted to the Single Point of Contact HUB, which can also be contacted on 01246 206514

Professional Referral

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