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  • Seafarer's Medicals - ENG1 | ML5

    This Pre Appointment Checklist is for ENG1 and ML5
  • NOTICE:
     THIS IS NOT A BOOKING FORM !

    Please fill this form only after you have made a booking on our website.

    You must fill this form prior to your appointment.

    Your clinician will review this form with you again on the day.

     

    If you require further guidance, please call +44 (0)20 4617 6186 or email us on yehs@yourexcellenthealth.org

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  • Seafarer Personal Details

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  • Seafarer's Medicals - ENG1

    ENG1 Seafarers Medical Form
  • Seafarer Family Medical History

  • Seafarer Medical History

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  • Seafarer Medical History

  • Seafarer's Medicals - ENG1

    ENG1 Seafarers Medical Form
  • Seafarer's Medicals - ENG1

    ENG1 Seafarers Medical Form
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    Thank You {givenNames}!

    You are about to submit your questionnaire!

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  • Seafarer's Medicals - ML5

    ML5 Seafarers Medical Form
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  • Seafarer's Medicals - ML5

    ML5 Seafarers Medical Form
  • Seafarer Medical History

  • Section 1-Cardiac

  • If YES - please answer the following:
  • Seafarer's Medicals - ML5

    ML5 Seafarers Medical Form
  • Section 2 – Endocrine and Metabolic

  • Seafarer's Medicals - ML5

    ML5 Seafarers Medical Form
  • Section 3 – Nervous System

  • Seafarer's Medicals - ML5

    ML5 Seafarers Medical Form
  • Section 4 – Psychiatric Illness

  • Seafarer's Medicals - ML5

    ML5 Seafarers Medical Form
  • Section 5 - Sensory

  • Section 6-Malignant Disease

  • Section 7-Musculoskeletal Limitations

  • Seafarer's Medicals - ML5

    ML5 Seafarers Medical Form
  • Section 8 – Respiratory System

    Is there a history of, or evidence of any of the following:
  • Seafarer's Medicals - ML5

    ML5 Seafarers Medical Form
  • Section 9 - Other Medical Conditions/Additional Information

  • Seafarer's Medicals - ENG1 | ML5

    This form is for ENG1 and ML5
  • End of Form

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    Please note that after submission, you will not receive an email confirmation.

     

    If you still have further queries, please call and ask to speak to Nick or send us an email. 

     

    Your Excellent Health Service - YEHS 

    25 Harley Street, LONDON, W1G 9QW

    020 4617 6186 | yehs@yourexcellenthealth.org | www.yourexcellenthealth.org

    YEHS! TO EXCELLENT HEALTH Your Excellent Health Service (YEHS) is the trading name for Dr Charlie Easmon Limited (07537353). YEHS is registered with & has been inspected by the Care Quality Commission (CQC): 1-349138322

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