Name of Practitioner (Surname):
(Christian Names in Full):
Address:
30 Windsor Terrace off St. George's Road
Present Work:
General Practitioner (Panel)
Age as at 1st January 1916:
Group A (Under 45) Lieut., R.A.M.C. (general service):
At the call of the local War Committee for my area, as instructed by the
Scottish Medical Service Emergency Committee, I am prepared to render the service
or services marked above. This offer is subject to the condition that, in the event
of such service requiring me to leave my present work, I am enabled to make
arrangements for having it carried in during my absence.
Additional Information:
[*modified category to be Age in 1917] [addendum to declaration at bottom of page:] 'This offer is subject to the condition that "I am found to be physically fit and that" in the event'...
To be returned to
The Secretary,
Scottish Medical Service Emergency Committee,
Royal College of Physicians,
Edinburgh.