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I think I may be drinking too much
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Help & Support
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Referral form
I think I may be drinking too much
I know someone who may be drinking too much
Services
Alcohol Counselling
Alcohol Brief Interventions (ABI’s)
Groupwork – Building Positive Pathways
Elevate Employability
Women’s Service
Community Justice First
Information
Alcohol Unit Guidelines
Alcohol and the LGBTI Community
Drinking and Driving/Drink Drive Limits
Alcohol and Pregnancy
Service User Involvement
Training & Courses
Diploma in Integrative Counselling & Psychotherapy
COSCA Counselling Supervision Course
COSCA Counselling Skills – Online Condensed [NEW]
COSCA Counselling Skills
COSCA Further Steps in Counselling
COSCA Group Counselling Skills
Staff and Volunteer Training
Workplace Support
GCA Moodle Cloud
About GCA
Room and Facilty Hire
Board Members
Meet Our Team
Our History
Our Mission, Vision & Values
Annual Accounts
Contact us
Work with us
Job vacancies
Volunteer Opportunities
Board member application
Volunteer Sign up
Volunteer Stories
Support us
Donations
Partners
Elevate-Glasgow
North West Recovery Communities
Scottish Alcohol Counselling Consortium
VSDAA
Donate
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Referral Form
Referral Form
Get help now, by filling in the form below.
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Referral type
*
Choose an option
I wish to refer myself
I am a health professional or agency
Referrers details: (If applicable)
*
Referrers details:
Name
*
First
Last
Gender
Male
Female
In another way
Prefer not to say
If you describe your gender with another term, please provide it below
D.O.B.
*
Please use format Day/Month/Year eg. 01121982
How would you like us to contact you?
Letter
Email
Phone or mobile
Text (SMS)
Address
*
Address
Postcode
*
Email
Telephone/ mobile
*
Telephone number
Where did you hear about GCA?
Choose an option
Rethink Your Drink website
Information stall
CAT Team
Social worker or Probation Officer
Web search
Facebook or Twitter
Poster, Leaflet or article
Other
please specify:
Ethnicity
Choose an option
Prefer not to say
Scottish
English
Irish
Welsh
British
Polish
Any other white background
Asian, Asian Scottish, any other Asian British or Asian Irish
Asian Chinese, Chinese Scottish, or any other Chinese British or Irish
Bangladeshi, Bangladeshi Scottish, or any other Bangladeshi British or Bangladeshi Irish
Indian, Indian Scottish, or any other Indian British or Indian Irish
Pakistani, Pakistani Scottish, or any other Pakistani British or Pakistani Irish
African, Caribbean or Black
African, Caribbean or Black Scottish; any other African
Caribbean or Black British or Black Irish
African, African Scottish, any other African British or African Irish
Caribbean, Caribbean Scottish, any other Caribbean British or Caribbean Irish
Any other African, Caribbean or Black background
Gypsy/ Traveller
Irish Traveller
New Traveller
Roma
Scottish Gypsy Traveller
Show person
Any other Traveller
How long has drinking been a problem?
Choose an option
Less than 3 Months
Between 3 & 6 Months
Between 6 & 12 Months
Between 1 & 2 Years
Over 2 Years
How often do you drink?
Choose an option
Daily
Some days
Binge
Most Days
Weekends
Weekly
Fortnightly
Monthly
Abstinent (none)
Service required
Choose an option
Information and advice
One to one counselling
Group counselling
Groupwork
Other
What times are NOT suitable for an appointment? (You can choose more than one)
Mornings
Afternoons
Evenings
Any other comments about suitability
How did you hear about GCA?
GCA website
Online search
Facebook page
Twitter page
By a doctor or health professional
By another serice or organisation
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