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Health Declaration Form for all visas

Health Declaration form for all Visas

Please fill in the HEALTH DECLARATION FORM. The questions asked are related to all the applicants included in your application including the primary applicant and the members of the family unit. Please write the name of the related applicant in case you want to provide more information in response to any question.

Health Declaration Form for All Visas

1. Given Name (as per passport)

2. Family Name (As per Passport)

3. Email address (Please use the same email address that is used on Brilliant Migration Club's CRM/Portal)

4. In the last five years, has any applicant visited, or lived, outside their country of passport, for more than 3 consecutive months? Do not include time spent in Australia. Please note this question is about all applicants including the primary applicant and the other members of the family unit included in the application. The department wants to assess the Polio Certificate requirements if you have visited any country that requires a Polio Vaccine Certificate.

Yes

No

Textarea

5. Does any applicant intend to enter a hospital or a health care facility (including nursing homes) while in Australia?

Yes

No

Please provide details who intends to enter a hospital or a halth care facility and why? Brilliant Migration might contact you for more details.

6. Does any applicant intend to work as, or study to be a doctor, dentist, nurse or paramedic during their stay in Australia?

Yes

No

Please provide little bit more details to evaluate it further.

7. Does any applicant intend to work or be a trainee at a child care centre (including preschools and creches) while in Australia?

Yes

No

Please provide little bit more details to evaluate it further.

8. Does any applicant intend to be in a classroom situation for more than 3 months (eg. as either a student, teacher, lecturer or observer)?

Yes

No

Please provide little bit more details to evaluate it further.

9. Has any applicant ever had, or currently have, tuberculosis? been in close contact with a family member that has active tuberculosis? or, ever had a chest x-ray which showed an abnormality?

Yes

No

Please provide little bit more details to evaluate it further.

10. During the visit or stay in Australia, does any applicant expect to incur medical costs, or require treatment or medical follow up for: blood disorder cancer heart disease hepatitis B or C and/or liver disease HIV infection, including AIDS kidney disease, including dialysis mental illness pregnancy respiratory disease that has required hospital admission or oxygen therapy other?

Yes

No

Please provide little bit more details to evaluate it further.

11. Does any applicant require assistance with mobility or care due to a medical condition?

Yes

No

Please provide little bit more details to evaluate it further.

Please press the submit button for the final submission of this form.

Thank you !!!!!!!

Melbourne Head Office

Brilliant Migration Club- Immigration agents & Education Visa Consultants, Address: 9 Ipswich Place, Craigieburn, Vic 3064 , Australia

+61 (4) 23360016

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