Brief Interventions referral formReferrer’s informationDoctor(Required)Practice(Required)Phone(Required)Email(Required) Client contact detailsNameDate of BirthPhone NumberAddressMental healthDoes the person have a Mental Health Diagnosis and if so, what is it?Is the person currently receiving other drug and/or mental health treatment? Please provide detailsMedication:Other infoAny alcohol or other drugs of concern? Please list:Please specify METHOD OF USE for PRINCIPLE DRUG OF CONCERN: Ingests Inhales (vapour) Injects Not stated