Odyssey House Trust Christchurch
Greers Road site is a smoke free premises
If you would like support to quit smoking please ask your worker about the support available

Please complete and submit the online form and complete the Information release Form. If you prefer, you can download and print out the forms with the links below, and once completed post/or email:

PO Box 34 009
Fendalton
Christchurch 5
Ph: 03 358 2690 
Fax: 03 358 2907

Click here to download a printable version

Adult Referral Form
  1. Referrers name
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  2. Referral Agency
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  3. Name
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  4. Ethnicity
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  5. Date of Birth
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  6. NHI
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  7. Current Use
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  8. Summary of current situation / presenting concerns
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  9. Current diagnoses
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  10. Current medications / Medical complications (e.g seizures)
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  11. Risk assessment: Self harm / suicide: Violence (incl arson / gender risk) Vulnerability
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  12. Previous treatment
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  13. Referrer recommendation for programme type and reason
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  14. Detox needs: medical / social
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