Name of Practitioner (Surname):
(Christian Names in Full):
Present Work:
General Practitioner, Panel
Age as at 1st January 1916:
Group A (Under 45) Lieut., R.A.M.C. (general service):
X (circled in red by SMSEC)
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:
[Two Forms with with note written] I have written for form Q, as this is a munition area there is an influx of workers. (in any can physically unfit)
To be returned to
The Secretary,
Scottish Medical Service Emergency Committee,
Royal College of Physicians,
Edinburgh.