Apply for Admission

FAQs | Costs | UK Admissions | International

    Filling in our online pre-admission form will help us respond to your admission needs more quickly.

    Please note that this form helps us assess your needs but does not oblige you to treatment.

    All information will be treated as strictly confidential and will be sent and stored securely.

    You need only complete as much as you can or feel able. Once you are satisfied please click the submit button and we will respond to your submission as quickly as possible.

    Prospective patient personal information

    Person completing the form

    Is this form being completed as part of a family / employer intervention?

    Person completing the form: personal information

    Referral source

    Alcohol / Drug Use

    Primary substance used

    Secondary substance used

    Third substance used

    Funding for treatment

    N.B. funding via NHS or social services needs to be agreed in advance of admission. Please select 'other' if you need to access this form of funding, and give further details.

    Health Insurance Information

    Admission

    Availability for admission:

    Comments

    Page last reviewed and clinically fact-checked | July 6, 2021