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Medical Condition Statement (Canada)

This is a statement of medical condition of a child for Canadian Citizenship and Immigration. The form provided here is simply a sample of what the actual form looks like.


This refers to the sponsorship you submitted on behalf of your orphaned relative or the child you have adopted or are in the process of adopting outside Canada, or intend to adopt in Canada.

According to section 118 of the Immigration and Refugee Protection Regulations a permanent resident visa may not be issued to the child unless you, as the adoptive parent(s) or child's guardian, provide a written statement confirming that you have obtained information about the child's medical condition. Given the commitment which parenting requires, it is in the child's best interests, as well as yours, that you be well and reliably informed about your child's health status. This may include health information provided by authorities in the child's country or information you obtain through an independent medical examination. Please note that the immigration medical examination completed as part of the child's application for permanent residence in Canada is done for immigration purposes and is not confirmation of overall good health.

Once you have obtained and reviewed medical information concerning the child you are sponsoring, please complete the portion below and forward it by mail or fax to the visa office outside Canada processing the child's application.


Office outside Canada: ______________________

File number: ______________________

Name of child: ______________________

Date of birth: ______________________

I, ______________________ (name of adoptive parent/guardian), have obtained medical information regarding

______________________ (name of child) for the purpose of section 118 of the Immigration and Refugee Protection Regulations. I wish to ____ continue ____ abandon the application for permanent residence made on his/her behalf.

Name of parent(s)/guardian (Please print) ______________________

Signature of parent(s)/guardian ______________________

Signed at ______________________

On ______________________ (date)

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