Basic Information
Documentation is processed and submitted electronically using “e-Medical“ on-line system. Please use our contact form to make an appointment. The contact form is on the bottom of this page in parallel with our policy. We do not make an appointment on phone. On the day of your examination please bring with you all items listed here on our websites – all forms should be in actual versions.
The medical examination is focused on the evaluation of physical and mental status. Fasting before examination is not necessary, nevertheless light breakfast only (minimum of sugar and fat) is recommended. During the examination you need to undress down to underwear. The medical examination represents the complex examination including vision examination, blood pressure measurement (15 years and older) and urinalysis. Urine sample is provided by the applicant during the examination. Urine sample is requested from the age of 5 years, in women out of menstruation period. Chest X-ray is requested from the age of 11 years. The examination duration varies roughly from 1 to 3 hours per person depending on certain request, health status of the applicant and additional examinations. More examinations are requested (beside physical examination e.g. X-ray, blood sampling etc.) more time is needed for the whole procedure certainly.
Medical examination (you were referred by the embassy/immigration office following your visa application and IME number was allocated to you)
Please take with you:
Following 3 Forms (printed)
• IMM 1017 Client Biodata (issued by the embassy individually)
• IMM 5743 Client Consent (please print it out from the embassy websites and fill in just your personal data in the header of each page)
• IMM 5419 Medical Report (please print it out from the embassy websites and fill in just your personal data in the header of each page)
Original passport + copy of the passport (page with photo); high quality copy is requested, please do not decrease the size (copy of the passport is the main source of personal data of the applicant to eMedical system)
Contact details of the applicant (residential address, e-mail, cell phone number) and the type of visa; to be written on a passport copy
2 passport format photos
Prescription (eye) glasses or contact lenses, if applicable
In case of any chronic diseases or congenital problems please provide existing specialist´s report
Pediatrician´s report in children under 18 years of age
Medical examination ”up-front“ (you were not referred by the embassy/immigration office and IME number was not allocated to you so far, you are planning to submit the exam confirmation together with your visa application)
Please take with you:
Following 2 Forms (printed)
• IMM 5743 Client Consent (please print it out from the embassy websites and fill in just your personal data in the header of each page)
• IMM 5419 Medical Report (please print it out from the embassy websites and fill in just your personal data in the header of each page)
Original passport + copy of the passport (page with photo); high quality copy is requested, please do not decrease the size (copy of the passport is the main source of personal data of the applicant to eMedical system)
Contact details of the applicant (residential address, e-mail, cell phone number); to be written on a passport copy
2 passport format photos
Prescription (eye) glasses or contact lenses, if applicable
In case of any chronic diseases or congenital problems please provide existing specialist´s report
Pediatrician´s report in children under 18 years of age
Advanced payment is requested
Contact for examination for Canada:
Jitka Patočková MD
Vítězné nám. 9, 160 00 Praha 6
Phone: +420 605 76 36 12