Clark, John

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

Reference Number: 
SMC/3/4/1/3 1:6
Name of Practitioner (Surname): 
Clark
(Christian Names in Full): 
John
Qualifications: 
LRCS, LRCP(Ed), LRCP&S(Glasg)
Address: 
Lyndhurst
City/Town: 
Skelmorlie, Ayrshire
Present Work: 

Totally unfit. Result of accident. Amputation of right leg

Age as at 1st January 1916: 
50
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: 
14/02/1916

To be returned to

The Secretary,

Scottish Medical Service Emergency Committee,

Royal College of Physicians,

Edinburgh.