Web Input of Booking for Visa Doctor

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Please be careful to fill in your correct information without typing errors. Only use English characters as international letters and accents are not recognized.
Please double-check your entries for any errors before submitting. Enter all information before submitting.
How did you hear about Visa Doctor?
Country that you are applying to for immigration:
Current Canadian Address
City  
Province  
Postal code  
Personal email address
Primary phone number (10 digits without hyphens or spaces)  
Second phone number (10 digits without hyphens or spaces)  
Immigration Lawyer/Paralegal/Consultant (if applicable)
Immigration Lawyer/Paralegal/Consultant email address (if applicable)
   
Include yourself and only any family members getting an immigration medical with you.
1st Family Member (You)
Given Name(s) (first name)    
Middle Name
Family Name (Last name exactly as it is on your ID document )  
Gender  
Date of Birth exactly as it is on your ID document (dd/mm/yyyy)
Birth Country
ID document type
ID document number
ID issuing country
ID document issue date (dd/mm/yyyy)  
ID document expiry date (dd/mm/yyyy)  
   
2nd Family Member  
Given Name(s) (first name)
Middle Name
Family Name (Last name exactly as it is on your ID document )
Gender
Date of Birth exactly as it is on your ID document (dd/mm/yyyy)  
Birth Country
ID document type
ID document number
ID issuing country
ID document issue date (dd/mm/yyyy)  
ID document expiry date (dd/mm/yyyy)  
   
3rd Family Member  
Given Name(s) (first name)
Middle Name
Family Name (Last name exactly as it is on your ID document )
Gender
Date of Birth exactly as it is on your ID document (dd/mm/yyyy)  
Birth Country
ID document type
ID document number
ID issuing country
ID document issue date (dd/mm/yyyy)  
ID document expiry date (dd/mm/yyyy)  
   
4th Family Member  
Given Name(s) (first name)
Middle Name
Family Name (Last name exactly as it is on your ID document )
Gender
Date of Birth exactly as it is on your ID document (dd/mm/yyyy)  
Birth Country
ID document type
ID document number
ID issuing country
ID document issue date (dd/mm/yyyy)  
ID document expiry date (dd/mm/yyyy)  
   
5th Family Member  
Given Name(s) (first name)
Middle Name
Family Name (Last name exactly as it is on your ID document )
Gender
Date of Birth exactly as it is on your ID document (dd/mm/yyyy)  
Birth Country
ID document type
ID document number
ID issuing country
ID document issue date (dd/mm/yyyy)  
ID document expiry date (dd/mm/yyyy)  
   
6th Family Member  
Given Name(s) (first name)
Middle Name
Family Name (Last name exactly as it is on your ID document )
Gender
Date of Birth exactly as it is on your ID document (dd/mm/yyyy)  
Birth Country
ID document type
ID document number
ID issuing country
ID document issue date (dd/mm/yyyy)  
ID document expiry date (dd/mm/yyyy)  
   
7th Family Member  
Given Name(s) (first name)
Middle Name
Family Name (Last name exactly as it is on your ID document )
Gender
Date of Birth exactly as it is on your ID document (dd/mm/yyyy)  
Birth Country
ID document type
ID document number
ID issuing country
ID document issue date (dd/mm/yyyy)  
ID document expiry date (dd/mm/yyyy)  
   
8th Family Member  
Given Name(s) (first name)
Middle Name
Family Name (Last name exactly as it is on your ID document )
Gender
Date of Birth exactly as it is on your ID document (dd/mm/yyyy)  
Birth Country
ID document type
ID document number
ID issuing country
ID document issue date (dd/mm/yyyy)  
ID document expiry date (dd/mm/yyyy)  
Please double-check your entries for any errors before submitting.