NADAPP Drug Treatment Information Request Form
Thank you for contacting the National Alcohol and Drug Abuse Prevention Programme (NADAPP), Ministry of Health. Kindly complete the following form to enable us to better understand and respond to your request.

Please note that this information will be treated with confidentiality. Information may also be used to monitor trends in drug use. Names and personal information will only be used for contact and recommendation purposes.
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Email *
Requester's Information
Please complete this brief section to enable us to contact you in future if we require any further information.
Requester's Name
Name of Organization (if applicable)
Requester's Phone Number  (eg. 1 868-123-4567)
Email Address
Client Information
Please input the following information about the person (self or other) for whom you are seeking help.
Client Name (Optional)
Location
If 'Other' was selected for location, please specify client's location
Client Age
Clear selection
Client Sex
Clear selection
Client Issue
Please provide any information which will help us better understand the needs of the person seeking help.
What drug(s) is/are commonly used by the client? (Select all that apply)
If you are unsure of the substance used, please describe the substance.
Please describe the problem (eg. how long has the person been using drug, how does it affect the person, family, job etc.)
Has the person ever accessed drug treatment and rehabilitation services?
Clear selection
If yes to the above, Please state how long ago and where treatment was accessed.
Please provide any other information which may be helpful to assist us with recommendations for treatment and rehabilitation services.  
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This form was created inside of Ministry of Health - Trinidad and Tobago. Report Abuse
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