Information on Cookies

To make the best use of our website, you'll need to make sure your web browser is set to accept cookies to ensure you receive the best experience.

For further information, go to our Contact Us page.

Fast Referral

Client Name *

Gender *

D.O.B *

Ethnicity *

Postcode *

Address Line 1 *

Address Line 2

Address Line 3

Town *

Area *

Client Contact Phone Number *

Client Email Address

Client Email N/A

Main Treatment Provider *

Partner Agency Client ID No.

Key Worker Contact Details

Name *

Telephone *

Email *

Problematic Substance/s *

Any special considerations? E.g mobility, work commitments, learning or literacy issues

Are there any known issues relating to safeguarding or other potential risks? If so please state.

Please state the course and area the learner would like to attend




Forgot your password? click here.

Enter your Email Address so we can find your details: