Medical Form  MF01/17

 This form needs to be completed by everyone who takes part in excavations or other field work with the Heritage Group.  The form should be presented at the first event of the year in a sealed envelope with your name on the front.  This will be kept sealed and handed to medical personnel in case of sudden illness or accident.   The sealed envelopes are destroyed at the end of each dig season and a new ones filled in at the start of the next season to ensure that any new medical conditions are included.

Full Name:

Address:


Telephone No:
Date of birth:

Details & telephone no. of
another person to be contacted
in an emergency:

Medical Information

Name & address of GP:


Blood group :

Date of last tetanus inoculation:

Known allergies:


Medical conditions:


Long term medication:


Signed……………………                     Date………….