Defib1 2026

1. Click ‘Get Form’ to open the defib1 document in the editor.
2. Begin with Part A: About You. Fill in your title, surname, first name(s), date of birth, driver number (if known), address, telephone numbers (home and mobile), postcode, and email using BLOCK CAPITAL letters and BLACK INK.
3. Proceed to Part B: About Your GP and Your Consultant. Enter your GP’s name and address, consultant's name and address, their contact numbers, and the dates you last saw them for this condition.
4. In Part C, list any other clinics you are attending along with the reason for attendance and relevant dates.
5. Complete the medical questionnaire regarding your Implantable Cardioverter Defibrillator (ICD) by answering all questions truthfully.
6. Finally, fill out the declaration section at the end of the form. Ensure all information is accurate before signing and dating it.

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