What service would you like to book?

The application form for your visa will tell you what service you need to book. Please note that you will need to complete a separate version of this form for every patient in your family.

General medical (adult)

General medical (child)

Limited medical

Follow up / Extra information requested by immigration

X-Ray Referral

Do you know your NZHR or NZER reference number?

Yes

Enter your NZHR reference number

No

What is your legal name?

Enter your name as it appears on legal documents like a birth certificate, driver's license or passport.

Given name

Other given names

Last name

When were you born?

Enter your birth date in numeric format.
For example, if you were born on the 1^st of January 1985, enter 1-1-1985 or, if you prefer, 01-01-1985.

Day

Month

Year

Do you have a support person?

You can bring a support person to your examination if you would like someone to give you advice or help to translate.

Yes

Please provide your support person's name and phone number

Name

Phone

No

How can Tasman Medical contact you?

Tasman Medical will use one of these to contact you about your booking, as well as for any follow-up questions. You will be able to select a preferred option in the next step.

Email address

Mobile phone number

What is your preferred contact method?

Email

Text message

Cellphone call

Support person

Do you know your GP's name?

Select 'No' if you are not enrolled with Tasman Medical.

Yes

Enter the name of your GP

No

Do you require an interpreter service?

Yes

No

Passport

Upload an image of the photo page of your passport

Do you have a current visa and know its expiry date?

Yes

When does your visa expire?

Day

Month

Year

No

What is your residential address?

Help with addresses

Use the address of the place you normally live.

If you are not living in a residence or are living in a shelter

If you are not living in a residence — for example, you are living on the street or in your car — enter No fixed abode in the first line instead of a street address, then enter the suburb and city where you normally live.

Do this even if you can be contacted at a night shelter or city mission; if so, use that address as your postal address.

If you are living on a boat

If you are living on a boat, use the first line to describe the place the boat is moored instead of entering a house number and street name.

If you do not want your address recorded

If you do not wish to have your address recorded on the NHI for some reason, enter the city you live in and put Request address kept off NHI on the first line instead of your street address.

House (or RAPID) number and street name

Suburb (optional)

Town/City/Rural Location

Postcode

What is your ethnicity?

Select all options with which you identify.

New Zealand European

Māori

Iwi (optional)

You may choose to state iwi or rohe affiliations here.
Please seperate multiple affiliations with commas; for example, Tūhoe, Ngāti Pikiao

Click a vowel with macron below to insert it into the iwi entry input

ā ē ī ō ū

Ā Ē Ī Ō Ū

Samoan

Cook Islands Māori

Tongan

Nieuan

Chinese

Indian

Other

Select any other ethnicities with which you identify.

Try to be as specific as possible; for example, select Tokelauan rather than Other Pacific.

After clicking on an option list, you can type the first letter of your ethnicity to get to the choice you want more quickly.

If you cannot find your ethnicity in the list, click Add another ethnicity not in the list and then type in one or more ethnicities seperated by commas.

First other ethnicity

Second other ethnicity

Third other ethnicity

Fourth other ethnicity

Fifth other ethnicity

Sixth other ethnicity

Add another ethnicity

Add another ethnicity not in the list

Thanks for completing this form!

You can send it to Tasman Medical by clicking 'Send form' below. Before you do so, please read the terms and conditions. By sending this form, you agree to these terms and conditions.

Terms and conditions

All immigration services must be paid before your appointment. These services are not refundable; therefore it is important to check you have selected the correct immigration medical service. You have selected no service.

Immigration Medical Service for Tasman Medical