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 then 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.

Please take extreme care to avoid errors in filling the form!

Immigration type	Please select a valid item.
Given names (First name)	Name is required.Full given names required.
FAMILY NAME (Last name)	Family name required.Full last name required.
Gender	Please select a valid item.
Date of Birth	Birth date is required.Format dd/mm/yyyy. Date format: dd/mm/yyyy
Country of birth	Country of birth missing.Minimum number of characters not met.
Address - Street	Address is required.Does not look valid.
Address - City	City is missing.Does not look valid.
Address - Prov or State	A value is required.Two characters required.Two letters only.
Address - Postal Code	Postal code or zipcode required.Does not look valid.
Telephone	Phone number required.Invalid format - use 0000000000.Must have 10 digits.Must have 10 digits.
Email	Enter Email address.Enter Email address or "none".Invalid format.
ID document type	Please select a valid item.
ID document Number	ID number required.Does not look valid.
ID issuing Country	Issuing country missing.Does not look valid.
ID document issue date	Date required.Format dd/mm/yyyy.Date format: dd/mm/yyyy
ID document expiry date	Date required.Format dd/mm/yyyy.Date format: dd/mm/yyyy
IME number (if available)	Must have 8 digits.Must have 8 digits.

Have you had an examination
in our office before?

Make a selection

Yes

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 that identifies the examination you are about to have. If you have already submitted your immigration application this number was probably assigned to you. It may be accompanied by a barcode.

If you are doing an "upfront" medical you probably do not have this number. In that case leave this box blank.

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)

A valid passport is always preferred. A copy of the passport is acceptable but then you will also have to show us another picture ID. A passport that is expired for less than one year may also be acceptable.

If you have no passport, a national ID card or a Canadian driver's license may be acceptable.

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 a temporary stay in Canada.

If you are applying for permanent immigration and do not fit the above categories, choose IMMIGRANT.

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