Immigration Medical and Chest X-ray Appointment Form
PLEASE FILL OUT ALL FIELDS.
For any fields that do not apply please select: "NO", "N/A" or type "N/A"
Please attach a copy of your passport here: *
*
What do you require an appointment for?
Full General Medical:
*
Yes
No
Full General Medical with Chest X-ray:
*
Yes
No
Chest X-ray only:
*
Yes
No
Further tests as required by INZ:
*
Yes
No
*Please note that Immigration New Zealand require a full medical examination, where the doctor will check your heart, lungs and abdomen. A chaperone will be present for the examination unless you indicate that you do not require one.
Chaperone required?
*
Yes
No
If applicant is under the age of 18, please complete the following:
What Visa category are you applying for?
Temporary Visa?
*
Yes
No
Residence Visa?
*
Yes
No
Type of Temporary Visa:
*
N/A
Visitor
Student
Worker with a job offer
Worker without a job offer
Residence Visa type:
*
N/A
Skilled/Business
Pacific Categories
Family
Humanitarian UNHCR
Humanitarian
Have you been selected for New Zealand's Refugee Quota Programme?* or are you applying under New Zealand's Refugee Quota Family Reunification Category? *This does not include applicants who have been recognised as refugees in NZ (or are the partner or dependent child of a person who has been approved refugee or protection status in New Zealand).
NZ Refugee Quota Programme?
*
Yes
No
Work to Residence?
*
Yes
No
Work to Residence type:
*
N/A
Worker
Family of worker
How long do you intend to stay in New Zealand?
*
Less than 6 months
6-12 months
12-24 months
More than 24 months
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