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Apply for Smarmore Castle Admission – Secure Form

Filling in our secure online pre-admission form will help us to respond to your admission needs quickly.

Please note that this form helps us assess and determine your treatment needs in advance, but does not oblige you to treatment.

All information you submit will be treated as strictly confidential and will be sent and stored securely.

You need only complete as much as you can or feel able.  Once you are satisfied please click the submit button and we will respond to your submission as quickly as possible.

    Is this form being completed as part of a family / employer intervention?

    Did a doctor or friend refer you to Smarmore Castle / how did you hear about Smarmore Castle?

    How many substances are being used (alcohol, drugs, etc)?

    We will not contact your GP without your permission.

    EU cross-border funding sometimes requires you to pay upfront for treatment, and receive reimbursement later. Is this something you would be able to afford?

    Insurance Policy Number

    Availability for admission:

    Anything you haven't mentioned that might be helpful to know.