CHECKLIST FOR CANADA IMMIGRATION MEDICAL EXAMINATION

IOM MANILA HEALTH CENTRE

APPLICANT’S NAME: LAST NAME, First Name, Middle Name AGE: Age
MOBILE NO: At least 2 mobile numbers EMAIL ADDRESS:
COMPLETE HOME ADDRESS: House No / Unit No / Building, Street Valid e-mail address
Barangay, Municipality/City, Province
TYPE OF VISA: Ex: Student, Work, Visitor, Permanent / Temporary Resident, etc.
TYPE OF MEDICAL EXAMINATION: WITH IME (IMM 1017E) UPFRONT MEDICAL EXAM

* Note: Please print out a copy of this checklist and bring along with your compiled requirements and printed forms (per applicant) on your
medical examination appointment date.

REQUIREMENTS
PLEASE BRING ONLY IF APPLICABLE
Reference: IOM MHC_Canada IME Requirements
Medical Report Form (IMM 1017E) Pertinent medical reports / results
* Sent by IRCC (skip if you are for Upfront Medical * If applicants have significant medical history or undergoing
Examination) treatment

Valid passport Eye glasses or contact lenses

Photocopy of the passport’s Bio Page

Two (2) Government-issued IDs PRINTED FILLED OUT FORMS
* One for the clinic and the other for the building security at
the Ground Flr.
Urine Test and Pregnancy Declaration Form
COVID-19 Vaccination Card and photocopy (for * For 5 years old and above
vaccinated applicants)
* Please note that COVID-19 vaccination is not a prerequisite to HIV Personal Information Sheet Form A
your medical exam * For 15 years old and above only

ADDITIONAL REQUIREMENTS FOR 0-18 YRS. OLD

Original PSA Birth Certificate

Photocopy of PSA Birth Certificate

School ID for the current school year if available

MINOR APPLICANTS TO BE ACCOMPANIED BY A GUARDIAN

Letter of Authorization
* From the parent sponsoring the visa application (signed)

Scan Copy of the Parent’s Passport

Guardian’s 2 Valid Government-issued IDs

MANILA HEALTH CENTRE

INTERNATIONAL ORGANIZATION FOR MIGRATION - THE UNITED NATIONS MIGRATION AGENCY
15F TRAFALGAR PLAZA, 105 H.V. DELA COSTA STREET, MAKATI CITY, PHILIPPINES 1227