Book an Appointment

First Name

Last Name

Date of Birth

Email

Phone/Mobile

Address

Address Line 1

Address Line 2

City

Postal Code

Are you applying for a grant or a renewal?

Grant

Renewal

In this section, tell us who your GP surgery is and which police force you are applying to. We need to know which surgery you are registered at so that we can request your medical records.

We hold details of each police force’s firearms department so we only need to know the name of the force you are applying to.

GP Surgery Name

GP Surgery Street Address

GP Surgery Town

GP Surgery Postcode

GP Surgery Phone Number

GP Surgery Email Address

Name of Police Force

Upload Signed Consent Form

Choose File

Have you declared any medical conditions on your firearms/shotgun licence application/renewal form?

Yes

No

Further Details

I consent to my report being emailed directly to the police via a non-NHS email address. I understand that, in line with police guidance, the police cannot be held responsible for any loss, delay, or inappropriate access to emails sent from a non-NHS email address.

Signature: Full Name (IN CAPITALS)

Firearms Medical Application Form

Consent Form

Consent Statement