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3. Nature of service:
   Community based
   Residential / In-patient
4. Postcode Area (e.g EH22):
5. Town/City:
6. Who can attend? Any Under 16s16-1818+21+Men onlyWomen onlyBoth sexesCouplesWomen with childrenCouples with childrenMen with childrenOther
7. Referrals from (please select all that apply):
   Any agency
   Self referral
   GP
   Health professional
   Social work
   Court
   Other
8. Drugs treated:
   
   Heroin/opiates/opioids
   Amphetamine/methamphetamine
   Cannabis
   Cocaine
   Ecstasy
   Benzodiazepines
   Over the counter medication
   Prescription medication
   Solvents/Volatile substances
   Other
9. Services required:
   Advice and information
   Counselling
   Detox/Abstinence
   Family services
   HIV and Hepatitis
   Needle exchange
   Outreach
   Prescribing
10. Rehabilitation and other services:
    Access to supported accommodation
    Aftercare
    Alternative therapies e.g. acudetox
    Drop-in sessions
    Drug testing
    Education and Training
    Education and Training by referral (by referral)
    Engage volunteers
    Engage peer volunteers
    Groupwork
    Sexual health
    Structured day programme
    Talks/training
    Stalls at exhibitions/seminars
    Other
11. Type of Service: Any VoluntaryStatutoryPrivateOther
12. Health Board Area: Any Ayrshire & ArranBordersDumfries & GallowayFifeForth Valley GrampianGreater Glasgow & ClydeHighland & ArgyllLanarkshireLothianOrkneyShetlandTaysideWestern Isles
13. Local Authority: Any Aberdeen CityAberdeenshireAngusArgyll & ButeClackmannanshireDumfries & GallowayDundee CityEast AyrshireEast DunbartonshireEast LothianEast RenfrewshireEdinburgh CityEilean Siar (Western Isles)FalkirkFifeGlasgow CityHighlandInverclydeMidlothianMorayNorth AyrshireNorth LanarkshireOrkneyPerth & KinrossRenfrewshireScottish BordersShetlandSouth AyrshireSouth LanarkshireStirlingWest DunbartonshireWest Lothian
14. Alcohol and Drug Action Team Area: Any Aberdeen CityAberdeenshireAngusArgyll & ButeAyrshire & ArranBordersDumfries & GallowayDundee CityEast LothianEdinburghFifeForth ValleyGreater Glasgow & ClydeHighlandLanarkshireMidlothianMorayOrkneyPerth & KinrossShetlandWestern IslesWest Lothian
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