Immigration Medical NZ
Appointment Request
Full Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Passport Number
*
Passport Expiry
*
-
Day
-
Month
Year
Date
Mobile Number
*
-
Area Code
Phone Number
Email Address
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Assessment Required
Please Select
General Medical Examination
Limited General Medical Examination
Chest X-Ray Request and Report Only
Type of Visa Application
Please Select
Temporary (Work/Study)
Residency
Work to Residency
INZ Health Case Reference
If available
Upload Passport First Page
*
Browse Files
Drag and drop files here
Choose a file
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of
We require a NON-REFUNDABLE admin fee of $20 to secure your booking. Thank you for choosing Meadowbank Medical for your immigration medical.
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Immigration Medical Assessment
$
20
NZD
Quantity
1
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Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
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