The National Health Service (General Medical Services) Regulations 1992

24.  If applicant is not in the FHSA’s medical list—

(1) name of any other FHSA in whose list he is included;

(2) particulars of any outstanding application for inclusion on the medical list of any FHSA;

(3) information about general medical services to be provided and, in particular, whether—

(a) including excluding	maternity medical services limited to
(b) including excluding limited to	contraceptive services
(i) excluding including	fitting of intra-uterine including devices
(ii) restricted not restricted	to patients to whom the doctor or partner provides other personal medical services
(c) including excluding limited to	child health surveillance services
(d) including excluding limited to	minor surgery services

(4) whether or not applied/intending to apply for—

(a) inclusion in minor surgery list,

(b) inclusion in child health surveillance list,

(c) inclusion in obstetric list; and

(5) undertaking to be bound by terms of service.