Immigration Medical Questionnaire

Fields marked with an * are required

Please answer truthfully, witholding information is usually more damaging to Visa applications than disclosing medical conditions.

Immigration applications are only declined for serious illness or disabilities. The final decision is made by Immigration NZ medical assessors, not Cromwell Family Practice.

This information is emailed to Cromwell Family Practice, not Immigration NZ, and will only be used for the purpose of an Immigration E-Medical, once you sign the Client Declaration in our clinic. You can discuss the answers with the doctor during your exam, and change answers if you have forgotten something.

Tick the boxes, then hit "Submit" at the bottom of the page.