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Self-referral form to U25's Substance Misuse Service

Self-referral form to U25's Substance Misuse Service

This form is for you if you wish to contact the U25’s Substance Misuse Service.

If you are a professional, please do not use this form. Instead see our referral page for professionals.

Contact us

The U25 Substance misuse Service offers free, flexible and confidential help. We have support services across East Sussex. You can get in touch by phone or email.

Phone: 01323 464 404
Email: U25's Substance Misuse Service

To ensure you can get the right support, we may need some information about you to:

understand how we can best help you
to develop a treatment plan
to help you make the changes you want

For more information about we use your data, your rights and how to complain, see our privacy notice.

To self-refer, please complete this form

There is a problem

Your preferred pronoun For example "he/him", "she/her", "they/them"

Your first name *

Your last name *

Your date of birth *

Day

Month

Year

Town where you live *

How do you want us to contact you? *

Phone

Your phone number *

Your email address *

Which drugs and/or alcohol do you want to discuss? *

Do you need any assistance, for example you may have a disability or need an interpreter?

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How can we help you?

Self-referral form to U25's Substance Misuse Service

To self-refer, please complete this form

There is a problem