You are here: Home › Archive › Addiction Rehabilitation › Make A Referral Make a referral Share I'm referring this person as a: * -- Please Select -- Friend or family member Health professional Legal, correctional or law enforcement officer Salvation Army officer / Salvation Army worker or volunteer Other NGO or community service Other professional body Reason for referral: * -- Please Select -- Alcohol addiction Other drug addiction Gambling addiction Other Your details First name: * Surname: Phone number: * Email address: * Re-enter email address: * Address line 1: Address line 2: State: * -- Please Select -- Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia International Postcode: How do you prefer we contact you?:-- Please Select -- Phone Email Via post Please comment on the best times and days to contact you: Do you have permission from the person you are referring to contact us?:-- Please Select -- Yes No The details of the person you're referring: First name: * Surname: * Location/suburb: * State: * -- Please Select -- ACT New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia International Select the nearest service centre: * -- Please Select -- Brisbane Canberra Central Coast Dubbo Gold Coast Illawarra Mount Isa Newcastle Normanton Northern Territory Penrith Shoalhaven South Australia Sydney Tasmania Townsville Victoria Western Australia Maroubra Age: * Phone number: * Comments: * Required field The Salvation Army is committed to upholding the Australian Privacy Principles. Click here for more information