Registration for Canadian medical exam

Before we can give you an appointment for your medical exam we must receive your registration.

We wil use this information to validate your case and prepare your eMedical file. Your file will be ready for you when you come in for your appointment.

A separate form is required for each family member.

Is this secure?

Yes. The information you submit is sent to our office by encrypted email. It is not stored on the server so it cannot be hacked.

Application type	Please select type
Given names (First name)	RequiredFull given names required.
FAMILY NAME (Last name)	RequiredFull last name required
Gender	Please select one option
Date of Birth	Required Format dd/mm/yyyy Date format: dd/mm/yyyy
Country of birth	RequiredMinimum number of characters not met
Address - Street	RequiredDoes not look valid
Address - City	City is missingDoes not look valid.
Address - Prov or State	A value is requiredTwo characters required.Two letters only.
Address - Postal Code	Postal code or zipcode requiredDoes not look valid
Telephone	Phone number requiredInvalid format - use 0000000000Must have 10 digitsMust have 10 digits.
Email	RequiredEnter Email address or "none".Invalid format
Pasport Number	ID number requiredDoes not look valid
Passport issuing Country	Issuing country?Does not look valid
Passport issue date	RequiredFormat dd/mm/yyyy.Date format: dd/mm/yyyy
Passport expiry date	RequiredFormat dd/mm/yyyyDate format: dd/mm/yyyy
IME number (if available)	Must have 8 digits.Must have 8 digits

What influenced you most to book with our clinic?	Select

I agree to the Terms and Conditions

Check the box if you agree

STOP!
Please double-check your entries before submitting!
Errors will be difficult to correct after your file is created.

Application type

Please select a valid item

Given names (First name)

Required
Full given names required.

FAMILY NAME (Last name)

Required
Full last name required

Gender

Please select one option

Date of Birth

Required
Format dd/mm/yyyy
Date format: dd/mm/yyyy

Country of birth

Required
Minimum number of characters not met

Address - Street

Required
Does not look valid

Address - City

City is missing
Does not look valid.

Address - Prov or State

A value is requiredTwo characters required.
Two letters only.

Address - Postal Code

Postal code or zipcode requiredDoes not look valid

Telephone

Phone number requiredInvalid format - use 0000000000
Must have 10 digits
Must have 10 digits.

RequiredEnter Email address or "none".Invalid format

Passport number

ID number requiredDoes not look valid

Passport issue Country

Issuing country?
Does not look valid

Passport issue date

Required
Format dd/mm/yyyy.
Date format: dd/mm/yyyy

Passport expiry date

Required
Format dd/mm/yyyy
Date format: dd/mm/yyyy

IME number (if available)

Must have 8 digits.
Must have 8 digits

What influenced you most
to book with our clinic?

Select one

I agree to the Terms and Conditions

Check the box if you agree

STOP!
Please double-check your entries before submitting! Errors will be difficult to correct after your file is created.

Please use only English characters. International letters and accents are not recognized by the eMedical system.

Immigration Medical Examination number.

This is an 8 digit number you may have received from IRCC. It is REQUIRED for Immigrant and Family Class categories. Not required for other categories.

Your own personal email, not work email, lawyer's email or friend's email. This may be used for confidential information.

Canadian or US number only. Local phone number preferred. This is needed to contact you if additional tests are required or other problems occur,

Format: 10 digits without hyphens or spaces.

Local address is preferred, even if it is not permanent.

For all dates on this form, be sure to use this format: dd/mm/yyyy
(numeric DAY, MONTH and full YEAR separated by slashes)

Immigration type that you are applying for, NOT your current status.

Family Class is for a sponsored family member, spouse or partner,

Student, Visitor, Worker are categories for people who have entered Canada on a temporary permit.

If you are applying for permanent immigration and have an IME number, choose IMMIGRANT.