Black, David Denholm

To be filled in by a Practitioner not holding a Commission
REGISTRATION FORM
MEDICAL RECRUITING SCHEME - 1916

Reference Number: 
SMC/3/4/1/2 2:4
Name of Practitioner (Surname): 
Black
(Christian Names in Full): 
David Denholm
Qualifications: 
LRCP&SEd
Address: 
Ellerslie
City/Town: 
Prestonkirk
Present Work: 

General Practitioner (Panel)

Age as at 1st January 1916: 
50
Group B (45 to 55) Part-time home civil work: 
X
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.
Date Form Signed: 
30/12/1915

To be returned to

The Secretary,

Scottish Medical Service Emergency Committee,

Royal College of Physicians,

Edinburgh.