Retired Police Officers Association Scotland

A wellbeing / welfare referral can be immediately submitted online by completing the form on this page further below. If you prefer to hand-write the form or complete it offline, you can access and/or download a PDF version via the QR code below. When we receive the referral, Tracy McKenzie, the RPOAS designated Single Point of Contact (SPOC) for our Transition & Wellbeing Project, will arrange for someone from the Project Team to get in touch with you to discuss the matter further.

To access and/or download a PDF version access a PDF version of the form – either click on the QR code with your mouse – or scan the QR code with your phone. Either option will lead you to a version of the form that can be completed online or downloaded for offline use. Once completed, please send the form – as an email attachment – to Tracy by clicking the envelope below. If it cannot be emailed, please contact Tracy (click on the envelope) to discuss alternative delivery options.

Be assured all contacts are dealt with in the strictest confidence

To immediately submit an online wellbeing / welfare referral form, simply complete all of the fields below and click the green SUBMIT button. If you then see a green message just above the SUBMIT button – the referral has been successfully sent to our Welfare Team. If something was wrong – the message will be in red – giving you a short explanation – please try again.

CONFIDENTIAL

RPOAS WELLBEING REFERRAL FORM

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I am referring myselfI am referring someone else

(this other person knows that I am making this referral) PLEASE NOTE: We can only accept a referral if the person knows that they are being referred.
If a person asks who referred them, we will disclose that information.

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DETAILS OF THE PERSON BEING REFERRED

First Name(s) Phone No. Member of which RPOAS Branch (if known)

Last Name eMail Address

DETAILS OF THE PERSON SUBMITTING THE REFERRAL (not required if you are referring yourself)

First Name Phone No.

Last Name eMail Address

I would describe myself as a:

Veteran (Retired Officer)Partner/Spouse of a VeteranChild of a VeteranParent of a VeteranPOA for a VeteranOther (explain below)

How do you know the person being referred?

What is your main concern? What would you like the RPOAS to assist with? What is the best way to contact you? Are there any days/times that are NOT suitable for call backs?

Please select the date of submission below

To clear the form, click the Reset button

CONFIDENTIAL