Immigration Medical Exam Booking Form

First Name(s) - as per passport

Last Name(s) - as per passport

Date of Birth

Gender

New Zealand Phone Number

Email

Street Number and Name

Suburb

City

PostCode

Country of Birth

Passport Number

Passport Issuing Country

Passport Date Of Issue

Passport Expiry Date

Exam Required

Chest Xray Required

Pacific Radiology

Chest x-rays are available at Pacific Radiology, Wanaka Lakes Health Centre (next door to the medical centre). No appointment is necessary.

Visa Category

Proposed Occupation in New Zealand

Have you recently arrived from or transited through China, Iran, Italy or Korea?

Have you recently arrived from or transited through Hong Kong, Japan, Singapore or Thailand?

Do you have a cough, fever or flu like symptoms?

Have you been in contact with anyone who may have been exposed to Covid-19 or have similar symptoms?