Online Registration for US Visa Applicants
Return to SLEC Homepage

Applicants for repeat medical examination whose medical examination was processed thru eMedical System, a new Heath Case is required prior to repeat medical examination.
Please contact us prior to scheduling your repeat medical examination.

Applicants 14 yrs and below should schedule their medical exam in the morning.









St. Luke's Medical Center Extension Clinic logo

ONLINE REGISTRATION

(For U.S. Immigrant Visa Applicants Only)


This online registration form aims to reduce registration time by having most of the applicant's information ready upon arrival at the registration area. Pre-registered applicants should only need to have their biometrics captured upon arrival at the reception area.

INSTRUCTIONS:

  1. COMPLETE ALL FIELDS. KNOW ALL DETAILS OF YOUR APPLICATION BEFORE ACCOMPLISHING THE ONLINE REGISTRATION FORM.

  2. FOR FAMILIES, AN ONLINE REGISTRATION MUST BE SUBMITTED FOR EACH FAMILY MEMBER. FAMILIES WITH INCOMPLETE ONLINE APPLICATIONS WILL NOT BE ACCOMMODATED AT THE RECEPTION AREA.


  3. PLEASE TYPE YOUR COMPLETE ADDRESS. DO NOT ABBREVIATE ANY DETAILS PERTAINING TO THE STREET, CITY, OR STATE.


  4. Once all fields have been filled out, Click on the 'Preview' button. The next step will display a preview of all data entered.
  5. Review data for errors. Use the form to correct them as needed, click 'Preview', to preview data to be submitted.
  6. If all data are correct, click on the 'Register' button to submit your registration.

PLEASE COMPLETE REGISTRATION BEFORE PRINTING THIS PAGE.
Your registration has NOT been submitted. This printout will not be honored when presented at SLEC. Refer to the instructions found at the beginning of the registration form to complete your registration.

NOTE: ONLINE REGISTRATION SUBMISSIONS ARE ONLY VALID FOR ONE MONTH. PLEASE REGISTER NO EARLIER THAN ONE MONTH BEFORE YOUR INTENDED DATE OF MEDICAL EXAM.

CASE INFORMATION

NVC Case Number* Confirm NVC Case Number*
Visa Preference Category*
Interview Date
Interview Source
Preferred Date and Time of Medical Examination*

APPLICANT DETAILS

Basic Information (as indicated in passport)

Name (Last Name, First Name, Middle Name)*
Date of Birth*
Gender*
Civil Status*
Birthplace *
 

Contact Information

FOR APPLICANTS CURRENTLY LIVING IN THE PHILIPPINES:

PHILIPPINE ADDRESS

 
 
 
 


FOR APPLICANTS CURRENTLY LIVING OUTSIDE THE PHILIPPINES:

OVERSEAS ADDRESS

Country*
 
 
 
 



Contact Number(s), separate with a slash*
Email Address*

Note: We are currently having issues sending confirmation emails to Hotmail/Live/MSN/Outlook.com email addresses. Please try a different email address.

Present Country of Residence*
Prior Country of Residence*

Passport Information

NOTE: Passport must be more than 6 months valid.
Passport Number*
Issued by (Country)*
Issue Date*
Expiration Date*

Additional Questions

Have you been issued a U.S. Tourist Visa?* No                    Yes
Issuance Date
Expiration Date


Previous Medical Examination at SLEC
Date of Previous Chest X-ray

PETITIONER'S INFORMATION

Name of Petitioner*
Is the Petitioner still alive?* Yes No
U.S. Address*

Relationship*



Contact Number*
Email Address*
Intended Port of Entry*