Register as a Doctor
Trained Overseas - International Medical Graduate
Personal/Contact Details
Last/Family name:
First name:
Preferred name:
Date of Birth (not compulsory):
Gender:
female male
Telephone (home):
Telephone (work):
Telephone (mobile):
Fax:
Current Residential Address:
Current Postal Address:
Email address:
Country of Citizenship:
Is this the country you work and reside in?
yes no
Which country do you work in, if different to your country of residence?
Are you considering coming to Australia with family? If so please list all names and dates of birth (for Immigration purposes) and their relationship to you:
Do you or any family member coming with you have a health problem that may affect the visa?
yes no
Please indicate your preferred method of contact:
Tel (home)  Tel (work)  Tel (mobile)  Fax   Email
Qualification Details
Where did you undertake your primary qualification?
Primary qualification type:
Year of qualification:
Are you currently working?
yes no
Current country that you are (or have been) registered in:
Other Countries that you are registered in:
Have you ever had disciplinary action taken against you by any medical board in the world?
yes no
Are you from a country where English is the first language?
yes no
If no, please indicate if you have completed the IELTS (International English Language Test) or another test, indicating results in each section, and when you undertook the test:
Work History
How many years General Practice experience have you had, and in which countries? (Please do not include any years of clinical attachment)
Years Country
Have you worked or been registered in Australia? If so, please provide details of registration, visa status, and sponsor if applicable:
Have you undertaken the AMC or FRACGP exams (either parts)?
yes no
If so please indicate which of the following you currently hold:
 MRCGP
 JCTPG
 PMETB
 CCFP
 FRNZCGP
Work Preferences
State you would like to work in:
City / country area you would like to work in:
Duration of stay:
Approximate start date (please take into consideration it will take at least 3 months for registration):
Referral
How did your hear about us?
If applicable, name of AGPR Rewards member: