We look forward to meeting you for your immigration medical. To ensure the process runs as smoothly as possible for you, we require some information to load onto your e-medical prior to your examination.
Please complete the following and bring back to us as soon as you can before your examination date. We will take the photograph of you at the same time:

Family Name

Given Name(s)

Title
MrMrsMsMissDr

Title Other (please specify)

Date of Birth

Gender
MaleFemale

Country of Birth

Contact Address

Email

Cellphone

I would like email confirmation that my health examination has been completed:yesno

Identity document type
Original PassportCertificate of IdentityNational ID Card

Identity document number

Issuing Country

Date of Issue

Date of Expiry

Which visa category you are applying? Please tick the correct boxes below. It is important we know this and if you are unsure, please check the immigration NZ website or contact immigration NZ. (Please select only one box)

Temporary
VisitorStudentWorker with job offerWorker without job offer

Residence
Skilled - BusinessPacific CategoriesFamilyStraight to ResidenceHumanitarian UNHCRBusiness / InvestorHumanitarian other2021 Resident Visa

Work to Residence
WorkerFamily of worker

What is your intended occupation in New Zealand (if applying under the work/skills category)?

How long do you intend to stay in NZ?
Less than 6 months6-12 months12-24 monthsMore than 24 months

Do you require?
Full Medical (including chest x-ray)Full Medical (not including chest x-ray)Chest X-Ray OnlyLimited Medical with x-rayLimited Medical without x-ray

Have you had ever been diagnosed as having TB (tuberculosis) before?
YesNo

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