Your life. Your plan.
Help with alcohol and drugs
Use the prompts that are helpful to you. You can write, draw, or ask someone to record your own words.
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What I want help with
Use words, pictures or a supporter to explain your concern and your own goal.
How to make my appointment accessible
Note communication, quiet space, timing, reminders, breaks and any chosen supporter.
Health and medicine questions
List what you want to discuss privately with the clinician, including withdrawal, epilepsy or medicine interactions.
Who I want involved
Agree who can help, what information they can receive and whether you want time alone.
The support offered
Record the service, named worker, treatment options, questions and agreed next step.
My emergency and backup plan
Record warning signs, how to call for help and who can support me. Ask about naloxone where relevant.
If my plan is difficult to follow
Agree whom to contact about cravings, missed appointments, returning use or changing needs.
My review
Record when we will check whether support is working. Keep this worksheet private; share only what you choose.