Questions 1 - 5:
Complete the form below. Write NO MORE THAN ONE WORD OR A NUMBER for each answer.
Oakham Surgery New Patient Form
| Example NEW PATIENT’S ROAD |
Answer Dawson Road |
| FULL NAME |
Mike 1 |
| WIFE’S FIRST NAME |
Janet |
| CHILDRENS’ FIRST NAMES |
1st 2 2nd 3rd 4th |
| ADDRESS |
52 Dawson Road 3 Melbourne |
| HEALTH CARD NUMBER |
4 |
| WIFE’S HEALTH CARD NUMBER |
will give later |
| PREFERRED DOCTOR SELECTED |
5 White |
Questions 6 - 10:
Choose the correct letters A, B, or C.
6When is Mike’s wife’s first appointment?
A.
B.
C.
7What is the surgery’s phone number?
A.
B.
C.
8What is the name of the girl with whom Mike is speaking at the surgery?
A.
B.
C.
9What’s the night doctor’s mobile number?
A.
B.
C.
10Which of the following does the surgery NOT make a charge for?
A.
B.
C.