Professional Referral

Referring Someone to Our Service

If you are a professional supporting someone with drug or alcohol use, you can make a referral to our service on their behalf.

Before You Refer

You must obtain the person’s consent before completing a referral.

How to Make a Referral

Due to technical issues, the online referral form is currently unavailable.

Please do not use the website referral form until further notice.

All third‑party referrals must be made using the Microsoft Word referral form.

Download and complete the Microsoft form found here
Email the completed form to the Single Point of Contact Hub:dhcft.daas@nhs.net

Need Advice or More Information?

If you would like to discuss a client you are supporting, or would like more information about the services we provide, please contact us:

Phone: 01246 206514
Email: dhcft.daas@nhs.net

Important Notice

PLEASE DO NOT USE THE BELOW WEBSITE REFERRAL FORM UNTIL FURTHER NOTICE.

We apologise for any inconvenience and will provide a further update once the electronic referral form has been reinstated.

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)

Client's email address (if known)

Problem Substance (required)

Are children's social care involved?

Yes

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

You might also be interested in…

Do you need help with drugs or alcohol?

Derbyshire Recovery Partnership