Military Veterans Military Veterans Please tell us if you are a military veteran here so that we can make sure you are offered the support and assistance you may need, now or in the future, as a result of your service. About YouName First Last Date of Birth MM slash DD slash YYYY Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Your Contact Telephone NumberTell Us About Your ServiceWhich Force did you serve? Royal Navy Royal Marines British Army Royal Air Force Please tell us the dates of your service.Were you discharged or retired due to ill health? Yes No Please tell us more about the reasons for your ill health discharge/retirement. OptionalConsentTHIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA. I consent to the practice collecting and storing my data from this form.