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Get UK FRM421/5 2012

Ions in blue or black ballpoint pen. If you are uncertain of any answer, leave the box blank and speak in confidence to the nurse. Please do not use correction fluid if you make a mistake on this form. C1 C2 A1 Have you ever had hepatitis B or hepatitis C or think you may have hepatitis now? A3 Have you ever injected yourself or been injected with illegal or non-prescribed drugs including body-building drugs or cosmetics (even if this was only once or a long time ago)? C4 C5 C6 In the l.

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