Online Referral

Referral form

  • Please select
  • Please select
  • DD/MM/YY
  • We can help you access your nearest service
  • We can speak to you about how we can help you
  • Please select
  • Please include any information you think would be useful
  • Please note, this does not include any drug prescribed to you by your doctor
  • Pressing send on this form means you are giving your permission for Inclusion Hampshire to store the information you have provided and contact you in-line with Data Protection legislation. We will contact you on the phone number or email provided so we can determine how we can best support you in our service.
  • This field is for validation purposes and should be left unchanged.

What help can we offer?

We want to enable you to make the changes that you want to make, whether that is to reduce or completely stop your use. We can provide a team of Doctors, Nurses, Recovery Workers, Community Connectors, Peer Mentors and Recovery Coaches to help you achieve this.

Success for us is when you hit your goals and enabling you to be happy, healthy and well. We look forward to achieving this with you.

We offer a free and easy to access service. If you are concerned and need to look for some advice or support then please call: 0300 124 0103, or use our online referral form.