Relationship Support Enquiry Form

Relationship support enquiry form

Your Name(Required)

First Last

Your Email(Required)

Your Phone(Required)

Contact Details

Name(Required)

First Last

Date of Birth(Required)

Email(Required)

Enter Email Confirm Email

Phone(Required)

Please leave the preferred phone number that we can contact you on.

Address(Required)

Address Line 1 Address Line 2 City County Postcode

Fire and Rescue Service Details

Please let us know about your fire and rescue service employment. This is for the purpose of confirming eligibility status. Nothing you share with us will be shared with your current or previous employers.

Fire and Rescue Service association(Required)

What is your association with the fire and rescue service?

Other association(Required)

Please specify your other association to the fire and rescue service.

Fire and Rescue Service(Required)

Employer

If you're not employed by a fire and rescue service, please enter your employer.

Month joined(Required)

What month did you join the fire and rescue service?

Year joined(Required)

What year did you join the fire and rescue service?

Month left

What month did you leave the fire and rescue service?

Year left

What year did you leave the fire and rescue service?

Were you medically discharged?(Required)

Yes
No
Not applicable

Were you made redundant?(Required)

Yes
No
Not applicable

Support Details

Preferred call times(Required)

In most instances it is necessary to speak to you about your enquiry and we would prefer to call you at a time that suits you. Please let us know the best time for us to make this call. If you are unable to engage in telephone conversation, then please identify as such and we will contact you by email. (Select all that apply)

About your situation(Required)

(Max. 1500 characters) - Please briefly describe your current situation.

If your situation involves others, please avoid disclosing personally identifiable information in this section.

If you are making a request on behalf of another person, please ensure you have their consent to make this request as we cannot process any request for support without it.

Voicemail consent

I am happy for the Fire Fighters charity to leave me a voicemail message about this enquiry

How did you hear about us?(Required)

Please let us know the ways you heard about the support we offer. (Select all that apply)

How did you hear about us? (other)

More information

The Fire Fighters Charity have a range of help and support that you can access. If you would like to learn more about these please select the ones that you would like to learn more about and we will include links to more information in your confirmation email.

Rest & Recharge Break
Hope Programme
Online health and wellbeing resources
Online on-demand workshops

The Fire Fighters Charity promises to protect and respect your privacy, we take this very seriously, the service that we provide you is completely confidential and we want to assure you that your personal information is safe. We process your personal data in accordance with our Data Protection Policy, please read our Privacy Policy for more.

Comments

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Norfolk Relationship Support Enquiry Form