Military Veteran/Military Family Form - Arlington Road Medical Practice

Section One

Military Veteran Details

We will record your Veteran Status on you rmedical record and this will be flagged on referrals where your conditon is directly related to your service.

Surname

First Names

Date of Birth

Is this your first time registering with a civilian GP following your discharge? If yes, please provide the Practice with a copy of your FMed113A.

Yes No

Which Force did you serve in?

Air Force

Army

Marines

Navy

If this is your first time registering with a civilian GP following your discharge, do you have a full paper copy of your medical records from the armed forces?

This is not my first time registering with a civilian GP following my discharge

This is my first time registering with a civilian GP and I do have a copy of my medical records

This is my first time registering with a civilian GP and I do not have a copy of my medical records

If you do not have your medical record and need the Practice to request this, please provide your Service Number and Regiments/Corp.

Section Two

Military Family Member Details

We will record yoru Military Family Member status on your medical recod and this will be flagged on referrals where your condition is directly related to your military family status.

Surname

First Names

Date of Birth

What is your relationship to the Service Personnel

Spouse

Partner

Child

Which Force do they serve in?

Air Force

Army

Marines

Navy

Military Veteran or Military Family form

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Military Veteran or Military Family form

Further Information