Name of Practitioner (Surname):
(Christian Names in Full):
Present Work:
General Practitioner on Panel
Age as at 1st January 1916:
Group B (45 to 55) Part-time home military work:
Group B (45 to 55) Part-time home civil work:
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.
To be returned to
The Secretary,
Scottish Medical Service Emergency Committee,
Royal College of Physicians,
Edinburgh.