Enfield Drug and Alcohol professional referrals Contact us Note: Questions marked by * are mandatory *This is a mandatory field. Date Referred individual information *This is a mandatory field. Name *This is a mandatory field. Date of birth *This is a mandatory field. Gender Please Select An Option MaleFemaleTransgender Rather not say Address including postcode GP details *This is a mandatory field. Email Landline no: *This is a mandatory field. Mobile number: Translation required? Please Select An Option YesNo Language Referral information *This is a mandatory field. Referring agency *This is a mandatory field. Referring worker *This is a mandatory field. Address *This is a mandatory field. Telephone number *This is a mandatory field. Email If on Probation – please state all details of order; RA, ATR, DRR, Probation Order, failure to complete may delay the process of this referral. Children’s Social Services – please include any plan/orders that may be in place. Mental Health team – please state current/ongoing input, failure to complete may delay the process of this referral. Reason for referral Risks/Concerns - If identified and referring from other agency please send with full risk history Does client consent to contact? Please tick each one below. Yes No Letter Email Text Phone Consent to voicemail
