St. Luke's Medical Center

Online Registration for Canada Visa Applicants

This online registration form aims to reduce registration time by having most of the applicant's information ready upon arrival at the registration area.


  1. You must have your received your Medical Examination Instruction Letter from the Canadian Embassy before proceeding to the Medical Examination.
  2. Answer all applicable fields. For items that do not apply, please type 'Not Applicable'.
  3. Once all fields have been filled out, Click on the 'Preview' button. The next step will display a preview of all data entered.
  4. Review data for errors. Use the form to correct them as needed, click 'Preview', to preview data to be submitted.
  5. If all data are correct, click on the 'Register' button to submit your registration.
Please select your preferred St. Luke's Extension Clinic location:
Preferred Date of Medical Examination

  • Name of Clinic and Year of Visa Medical Examination

  • Category Applied for

Applicant's Details

  1. Family Name

    Given Name

    Middle Name

    ALIAS/A.K.A. Name on Passport, if any

  2.  (mm/dd/yyyy format)

  3.   Male          Female

Contact Information

  1. House No./Street


    Province                                Postal Code

Passport Information

  1.  (mm/dd/yyyy format)

Visa Application Information

  1. For upfront medical exams, please put "UPFRONT".