Has the applicant been previously examined for immigration into Canada?(Yes or No, if Yes, pls show Date, City and Country)
    申請人是否曾經為移民加拿大而接受體格檢查？
    (是或否，如果是，請提供時間地點)

    Has the applicant used addictive or mood alerting drugs?(Yes or No)
    申請人是否服用上癮藥物或興奮劑？(是或否)

    Does the applicant consume alcohol? (Yes or No, if Yes, How much?)
    申請人是否酗酒？(是或否，如果是，數量？)

    Does the applicant smoke or has the applicant ever smoked tobacco?
    (Yes or No, if Yes, How much?)
    申請人是否吸煙或曾經吸煙？(是或否，如果是，數量？)

    Has the applicant ever suffered from or been told he had any of the following conditions?(Yes or No)

    Head or neck injury 頭部或頸部受傷
    Nose or throat trouble 鼻或喉疾病
    Ear trouble or deafness 耳部疾病或耳聾
    Eye trouble 眼疾
    Chronic cough or asthma 慢性咳嗽或氣喘
    Tuberculosis 肺癆
    Other lung disease 其他肺部疾病
    High blood presure 高血壓
    Heart trouble 心臟病
    Rheumatic fever 風濕性熱
    Diabetes mellitus 糖尿病
    Endocrine disorders 內分泌疾病
    Cancer or tumor 癌或肺瘤
    Rheumatism, joint or back troubles 風濕性關節或脊背疾病
    Mental disorders 精神病
    Faiting spells, fitsor seizures 突發性眩暈，痙攣或癲癇
    Chronic skin condition 皮膚病
    Stomach pain or ulcer 胃病或潰瘍
    Other abdominal touble 其他腸胃疾病
    Kidney or bladder trouble 腎病或膀胱疾病
    Sexually transmitted disease 性病
    HIV positive 愛滋病陽性反應
    Genetic or Familial disorders 遺傳性疾病
    Typhoid fever, malaria, tropical disease 傷寒，瘧疾或熱帶病
    Operations 曾經動過手術
    Have you ever had a blood transfusion 曾經接受輸血

    Is the applicant now taking any medication or receiving treatment which must be continued in the future?(Yes or No)
    申請人是否正在服藥或要繼續治療？(是或否)

    Please elaborate on all \"yes\" answers of questions include significant dates and know treatment.
    對以上回答“是”的問題請詳細說明，包括治療日期。

    Physical examination to be completed by the examining physician.
    體格檢查，由檢驗醫生完成本報告。

    Upon medical examination are there any abnormalities of the following:
    體檢中是否發現以下不正常的情況：

    Head and Neck 頭和頸部
    Mouth and throat 口腔和喉部
    Ears 耳
    nose 鼻
    Eyes including fundi 眼睛包括眼底
    Heart 心臟
    Chest, lungs and breast 胸，肺和乳房
    Abdomen, liver, spleen,etc. 腹部，肚，脾等
    Genito-urinary system 泌尿生殖系統
    Hernial sites 疝氣
    Extremities and spine 脊柱和四肢
    Nervous system 神經系統
    Skin including surgical scars 皮膚包括手術疤痕
    Lymphatic system 淋巴系統
    Evidence of mental abnormality 精神病癥狀
    Any other abnormalities 其他不正常情況
    Female applicant pregnant if yes, date of L.M.P. 女申請者是否懷孕？如是，注明最后月經日期
    Is the appllicant now taking medication or receiveing treatment of any kind? If so, specify
    申請人目前是否服用藥物或接受其他治療？如是，請說明
    Height 身高

    Weight 體重

    Visual acuity with glasses if worn 視力(如近視則測矯正視力)

    Hearing whispered voice(normal: 6 meters(20 feet)) 聽力

    Blood presure 血壓

    If abnormal repeat B.P. after resting 如果不正常，稍后再量

    Pulse rate 脈搏

    Pulse rhythm 脈搏節率

    Mental development 智力發育(正常與否)

    Please elaborate on all \"yes\" answers or abnormalities
    請對回答是“是”的問題加以詳細說明

    Routine blood serologial tests for syphils (Candidates 15 years of age and older)
    梅毒常規血清試驗(15歲以下申請人免檢)

    FTA-ABS.(only in VDRL positive)

    Urinalysis (Candidates 5 years of ages and older)
    尿檢(5歲以下免檢)

    Protein 蛋白
    Sugar 糖
    Microscopic 顯微鏡檢驗結果 If abnormal, repeat.
    Large postero anterior chest X-ray film and report (required for all applicants 11 years of ages and older)
    所有11歲以上人士必須進行X光檢查。

    Skeleton/soft-tissue
    Cardiac shadow
    Hilar & mediastinal nodes
    Hemidiaphragms and CPAs
    Parenchymal infiltrates
    Pulmonary nodules
    Pleural fibrosis/effusion
    Interstitial fibrosis
    Cavitation
    Other abnormalities
    以上資料來自加拿大體檢報告書，注意其中并沒有提到對肝功能的各種檢查。