EmailMeForm
Patient Form - IME - Confirmation of Appointment
You MUST complete this form to confirm your appointment.
You must bring to your appointment:
- your valid ID
- your payment (debit or cash)
- your glasses or contact lenses if you require (please wear)
What to expect at your appointment:
- give a urine sample (make sure you are well-hydrated before arrival)
- a blood sample (you may eat and drink before your appointment)
- a chest x-ray
IME or UCI number
If you have received documentation from IRCC, please insert your IME or UCI number here. If you do not have this number, you may leave this field blank. Those completing an upfront medical, express entry, or TR to PR Pathway may leave this filled blank. Spousal or dependent child sponsorship MUST provide their IME number.
I will present to my appointment with the following valid ID:
*
Please select
Original Passport
Canadian Driver's Licence
Refugee Protection Claimant
Refugee Travel Document
OAS Travel Document
National ID Card
Red Cross Travel Document
UN Laissez-Passer
Seaman's Book
Passports are preferred when possible
Applicant's valid ID Number
*
If you are presenting with a Passport, please insert your passport number here. If you are presenting with a Driver's Licence, please insert your Driver's Licence number here, etc.
Applicant's Country of Citizenship
*
This is the country for which you hold the passport.
Applicant's Country of Birth
*
This is the country listed on your passport, where you were born.
Date of Issue
*
DD
/
MM
/
YYYY
of the valid ID you are presenting.
Date of Expiry
*
DD
/
MM
/
YYYY
of the valid ID you are presenting.
Applicant's First Name
*
Name as it appears on your valid ID
Applicant's Middle Name
Name as it appears on your valid ID
Applicant's Last Name
*
Name as it appears on your valid ID
Date of Birth
*
DD
/
MM
/
YYYY
Gender
*
Male
Female
X (another gender)
Applicant's Canadian Home Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Home address MUST be your Canadian Home address.
Email
*
Phone Number
*
###
-
###
-
####
I am applying for the following category:
*
Worker
Visitor
Refugee
Student
Family or Spousal
Permanent Resident
Other
I don't know/I'm not sure
By submitting this form I agree to the following:
*
I am aware that the office requires 48 hours' notice for any cancellation
I understand that if I do not show up to my scheduled appointment, I will be charged the $100 no-show fee.
I do NOT have fever, cough, shortness of breath, sore throat, runny nose, or any other symptoms of COVID-19.
