Self-Referrals

If you are self-referring or referring on behalf of a relative or friend, please complete our Self-Referrals form below. Alternatively you can download a Microsoft® Word version here to complete and post or fax back to us using our contact details at the bottom of the page.

If you’d prefer to have a chat with us about our services, please call us on 0131 315 4466 or email registrations@pepscot.org.

Please note that we are unable to register group members with a dementia diagnosis or personal care needs. We apologise for any inconvenience caused.

    Self-Referrals Form

    Complete the form below to register with us.
    Fields marked with an asterisk (*) are required.

    Service user details








    Please provide an email in the field below so we can send you a confirmation message with the details you have provided for reference:

    Emergency contact details

    GP contact details


    Medical information

    Characters remaining: 300

    Characters remaining: 300


    If you selected 'Other' from the options above, please specify in the field below:


    Additional information


    If you selected 'Other' from the options above, please specify in the field below:


    If you selected 'Other' from the options above, please specify in the field below:

    PEP attendance

    Characters remaining: 1000