Client Referral | Chandos House Treatment for Addiction CIC

Refer your client or patient

Our policy is to try and help men who recognise that their use of alcohol and/or other substances is a serious problem for them in their lives.
Chandos is fully committed to guiding those who have a genuine commitment to doing something about it, towards an abstinence led recovery from addiction.
If you would like to refer a client to Chandos House for assessment then please download a copy of our client referral form and return the completed document to info@chandoshouse.org. Alternatively please feel free to contact us directly on Tel. (01179) 243071 or the email address supplied above.

Free pre-residential support is available at Chandos House (subject to approval and entirely dependent on the client’s individual requirements). For further information about the availability of this support, please contact us directly to discuss this option further.

There will be occasions when we will be unable to help because the applicant needs more than we can offer; in these situations, we are happy to discuss other options which may be available. Please do not hesitate to contact a member of our team for further information.

Refer someone for a place

Please complete the referral form below, giving as full a picture as possible of applicant. All information is held in the strictest of confidence and will be destroyed if we are unable to offer the applicant a place. Alternatively you may download an application form here.

Name of applicant:

Applicant's date of birth:

Name of treatment centre/Counsellor/Keyworker:

Treatment Centre/Counsellor/Keyworker's Address

Treatment Centre/Counsellor/Keyworker's Telephone:

Treatment Centre/Counsellor/Keyworker's Email_address:

Care Manager/Funder:

Care_Manager/Funder's Address

Care_Manager/Funder's Telephone:

Care_Manager/Funder's Email_address:

Has funding been confirmed for treatment at Chandos House? Has funding been confirmed for treatment at Chandos House? Yes No

Brief history of your client’s use of drugs and/or alcohol? Which drugs, in what quantity, how frequently & for how long?

How has the applicant progressed so far? What has been the focus of this treatment?

Details of past and current legal situation (if applicable) Please include forthcoming court appearances, probation or D.T.T.O.

Give details of any significant family involvement during your client’s treatment:

Is there a psychiatric history? If so, please supply a medical report.

Has the applicant presented any behavioural/attitude problems whilst with you?

Has the applicant been given any therapeutic conditions, warnings or contracts during your work together? Please give full details

Does your client have any other requirements that we should be aware of?

Please provide any other information that you feel is relevant to this referral:

9 + 7 =