Medical Surveillance for Inactive Tuberculosis (TB) - Region of Peel - peelregion 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name in the designated fields for Family and Given Name(s). This ensures accurate identification.
3. Fill in your Date of Birth using the format (Y/M/D) to maintain consistency.
4. Select your Gender by checking either MALE or FEMALE.
5. Provide your Country of Birth and Date of Arrival in Canada, again using the (Y/M/D) format.
6. Complete the Immigration File# field, followed by your full address including street name, city, province, and postal code.
7. Enter your phone number in the provided space for easy contact.
8. For physician use only, ensure that the Exam Date and Chest X-Ray Date are filled out correctly along with the Physician’s Name and contact details.
9. Finally, sign and date the form where indicated. Keep this Certificate with your Immigration papers for future reference.

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