Please register to access our services by completing the following form. Alternatively you can download our referral form (.pdf) here.

Young Person's information

Name and contact number
This could include CYF, school counsellor, number 10 etc

Referrer information (if different from above). If you are referring yourself please just put "self" in these boxes.

(If referring to Youth Brief Intervention Service in South Canterbury)

What' going on?

Please outline alcohol/drug or mental health concerns
e.g. young person's family situation, accomodation, education, employment, relevant history