• Immigration Booking

    Immigration Booking

    Please fill out for all new e-medical cases, our staff will call you with a time that suits for your exam. Wait time is usually 1-2 weeks . You must see a Panel Clinic before having Xrays. Please email, not phone, with inquiries.

  • Cromwell Family Practice - Panel Physician Clinic

    2 McNulty Road Cromwell

    txt 021 2680422    email immigrations@cromwellfamilypractice.co.nz

  • Date of Birth*
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  • Gender*

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  • Issue Date Passport*
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  • Expiry Date Passport*
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  • Medical Questions

    Please answer fully, it is better to disclose all medical history fully, and will usually not harm your Visa application. The doctor will discuss with you before uploading these answers to Immigration NZ.
  • Have you ever had tuberculosis or treatment for TB?*
  • Have you ever had close contact with any person with tuberculosis?*
  • Any Treatment in hospital, repeated treatments, any operations, including during childhood?*
  • Ever had treatment for psychological or psychiatric problems?*
  • Have you had a positive test for HIV / AIDS?*
  • Have you had a positive test for Hepatitis B or C ?*
  • Cancer or malignancy in the past 5 years?*
  • Diabetes?*
  • Heart Condition?*
  • Blood Condition (including thalassaemia)?*
  • Kidney or Bladder condition?*
  • Any physical or mental disability, any restrictions on ability to study or work?*
  • Any addiction to drugs or alcohol?*
  • Do you take any regular medication (tablets, birth control, inhalers, injections)?*
  • Any inherited (genetic) conditions, any auto-immune disorders?*
  • Any neurological problems eg paralysis, stroke, multiple sclerosis?*
  • Any significant Health problems or early death in your immediate family?*
  • Are you pregnant?*
  • Completed by*

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