Tell us if you are a veteran

Who are you completing this form for?

For example, on behalf of a child or dependent

Yourself

Someone else

What is your name?

First name

Last name

What is your date of birth?

For example, 31 3 1980

Day

Month

Year

What is your sex?

As recorded on your medical record

Male

Female

Other

What is your postcode?

The one used to register with your GP

What is your phone number?

What is your email address?

Anyone else with access to your email account may see responses sent to you

What is your current address?

Building and street

Town or city

Postcode

Have you ever served in the UK Armed Forces and/or been registered with a Ministry of Defence GP in the UK or overseas?

Regular

Reservist

Veteran

What was your address before enlisting?

Building and street

Town or city

Postcode

Service or personnel number

What was your enlistment date?

For example, 31/03/1980

What was your discharge date?

For example, 31/03/1980

Terms and conditions

I confirm that this is not urgent and understand the surgery cannot help while it is closed. If I need help right now, I will visit NHS 111 online or call 111. In an emergency, I will call 999 or go to A&E.

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