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APPLICATION FORM

    Fields marked with an * are required

     

    Application Type*

     

    PERSONAL DETAILS

    Your full name*

    Your date of birth (D.O.B.)*

    Street*

    Town*

    County*

    Postcode*

    Telephone No.*

    Email address*

    Issuing Police Force*

     

    GENERAL PRACTICE DETAILS

    Name of GP*

    Name of Practice/Surgery *

    Street*

    Town*

    County*

    Postcode*

    Telephone No.*

    Email address (optional)

     

    MEDICAL CONDITIONS

    Have you declared any medical conditions?

    If yes, please detail here... (optional)

     

    FIREARMS MEDICAL REPORT CONSENT FORM

    We need your consent by ticking the box to complete this review. We will need a copy of your medical records and your formal permission to hold and review your records.

    WHAT WE NEED

    We will need a full copy of your medical records. You are entitled to a copy of your records, without charge, under the General Data Protection Regulations. Your GP practice is required to respond to your request and provide you with a copy of your records within 30 days. Your GP might offer you several alternatives. The copy we need must include all of your records including any letters and copies of any old records cards that may still exist but may be paper or electronic.

     

    YOUR MEDICAL RECORDS

    I will send my medical records via:*

    Email address: info@shotgunmedicals.com
    Postal address: Shotgun Medicals, 4 Victoria Mount, Oxton, Wirral, CH43 5TH

     

    TERMS & CONDITIONS (please tick to confirm)

    How did you hear about us?*

     

    ACCEPTANCE & SIGNATURE

    Print Name*

    Date*

     

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