Hong Kong International Medical Clinic, Beijing

Make an Appointment for the Examination

Medical Report
Section A
Client Identification
& Summary

Visa Office & Number:*

IMS Serial Number:

FOSS Client ID:

Surname: (provide alias or AKA names in brackets):*		Forename/First Names:*
Date of Birth*	Country of Birth*	Sex*	Marital Status*	Required from all applicants. Must be taken within six months of the medical examination
Appointment*
Mailing Address (for use if further medical information is required) Telephone Number:* E_mail Address:*		Category of Applicant
		Intended Canadian Destination