Name of Practitioner (Surname):
(Christian Names in Full):
Present Work:
General Pracitioner (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:
This form arrived too late to arrive before Dec 31st. This is the first mail since this communication arrived.
To be returned to
The Secretary,
Scottish Medical Service Emergency Committee,
Royal College of Physicians,
Edinburgh.