Migrant Health Evaluation Form

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Migrant Health Form

Thank you for starting the process with Accu Diagnostics Ltd. To ensure a smooth experience, please have your passport ready as you proceed with the migrant health evaluation form. Your cooperation is greatly appreciated, and we’re here to assist you every step of the way. If you encounter any questions or need support, don’t hesitate to reach out. We’re dedicated to making your health assessment convenient and efficient. Thank you for choosing Accu Diagnostics Ltd.

Cell Phone Number

Additional Phone Number

Demographic Information

Name

First

Middle

Last

Date of Birth

Nationality

Sex

Male

Female

Marital Status

Single

Married

Widowed

Divorced

Passport Issuing Country

Passport Number

Please upload a copy of your passport.

Maximum file size: 5MB

Please upload a copy of your Work Permit Card.

Maximum file size: 5MB

Address

City

State/Province

Address

Country

Occupation

Employer

NHIP Number

NHIP-

Signature

Clear

Date

If you are human, leave this field blank.