How To Self Exclude
To download the self exclusion forms click here
Q: Where can I find out where to obtain and submit a Self Exclusion agreement form?
A: Self Exclusion Agreement forms can be downloaded from www.countmeout.org.uk. The website will also detail where forms can be obtained from and which agency/surgery will carry out an assessment and counter sign the forms. Under the Count Me Out Alcohol Self Exclusion Scheme it is optional for licensed premises to provide the agreement forms and information sheets. If they decide to provide this service then this will be clearly marked on the members premises list found on the Count Me Out website.
Q: How many copies of the Count Me Out Alcohol Self Exclusion agreement do I need to complete?
A: An agreement form can be copied if necessary. The important thing is that one copy is given to the person choosing to exclude themselves and one copy is sent along with a photograph of the person to the Count Me Out Team. We do recommend that the agency counter signing and submitting the agreement keep a copy for their records.
Q: Why have I got to assessed by a Health Care Professional before I can self exclude?
A: It some cases it wouldn’t be safe for a person to suddenly stop drinking and withdraw from alcohol alone. Alcohol withdrawal (self exclusion) should only be done with professional supervision. Withdrawal from alcohol can be uncomplicated or it can be life threatening.
Any person wishing to self excluded must be assessed by a local Alcohol support agency or a Health Care Professional such as a GP or Registered Nurse. Following a consultation with a health care professional an assessment will be made as to a persons suitability to participate in the Count Me Out Alcohol Self Exclusion Program. Once a person’s suitability for the program has been confirmed their self exclusion will be activated and their details added to their local Alcohol Self Exclusion scheme database.
Attempting to withdraw from alcohol without professional management is difficult and in some cases dangerous. With the Count Me Out managed self exclusion program that involves the support of the wider community we can all help a vulnerable person successfully withdrawal from alcohol successfully.
