The information you need to provide is quite simple, but you may like to ask a relative, neighbour or carer to help you complete the distinctive yellow form.

A passport sized photograph may be attached to the form, but this is only needed where there is more than one person living at the premises (to allow identification).

The information required on the yellow form is:

Your full name, a very brief physical description, and your religion.
Your Doctor’s name and Surgery address and telephone number.
A brief description of any medical conditions you are suffering from – your Doctor or carer may help if you are uncertain.
The names, addresses and telephone numbers of two people who may be contacted in the event of a sudden illness or accident.
Details of any pets which may be on the premises.

In addition, we strongly recommend that you also keep a copy of your repeat prescription list. This is produced every time a repeat prescription is ordered, and this information is of great value to the Ambulance Service. (Paramedics are able to administer drugs, but need to know of any drugs you are already taking to eliminate the risk of drug interactions.)