If you are returning from the Armed Forces: Address before enlisting: Service or Personnel Number: Enlistment date: If you are registering a child under 5 I wish the child above to be registered with the doctor named overleaf for Child Health Surveillance Yes No If you need your doctor to dispense medicines and appliances (Note: not all doctors are authorised to dispense medicines.) I live more than 1 mile in a straight line from the nearest chemist.
If you are returning from the Armed Forces: Address before enlisting: Service or Personnel Number: Enlistment date: If you are registering a child under 5 I wish the child above to be registered with the doctor named overleaf for Child Health Surveillance Yes No If you need your doctor to dispense medicines and appliances (Note: not all doctors are authorised to dispense medicines.) I live more than 1 mile in a straight line from the nearest chemist.
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