Temporary Registration Form – The Medical Board of Trinidad and Tobago

Demographics

First Name (and all middle names if exist)

Last Name

Gender

Nationality

Date of Birth

Address

Email Address

Contact Numbers

Qualifications (Basic)

Date Obtained Upload Scanned Qualification (JPG/JPEG/PNG/PDF only)

Supporting Documents

Important: You must upload clear scans/photos of the original documents AND copies where applicable.

Identity Proof

Upload Completed Application Form PDF Download Application Form PDF

Please download, complete, scan and upload the official application form above.

Passport-sized Photo (JPG/PNG)

Certificate of Character (signed)

I confirm that I have read, understood, and agree to abide by the Medical Board of Trinidad and Tobago Code of Ethics . (required)

Effective Date of Disciplinary Action: Country: State/Province: Name of Medical Board/Council: Reason for suspension/revocation/restriction:

Date of Official Notice of Denial: Country: State/Province: Name of Medical Board/Council: Reason for denial:

Date of Medical Board/Council’s Decision: Country: State/Province: Name of Medical Board/Council: Explanation:

Date of Investigation/Proceeding: Country: State/Province: Name of Medical Board/Council: Explanation: