Name of Practitioner (Surname):
(Christian Names in Full):
Present Work:
General Practitioner (Panel)
Age as at 1st January 1916:
Group B (45 to 55) Part-time home military 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.
Additional Information:
Comment next to 'X': or military provided same as in Paisley and does not interfere with my present duties. Has scored out the final sentence of the conditions.
To be returned to
The Secretary,
Scottish Medical Service Emergency Committee,
Royal College of Physicians,
Edinburgh.