Provisional Registration Form – The Medical Board of Trinidad and Tobago

How to use:

This is the provisional registration form. Please fill out all required fields. If you have questions, create a support ticket.

Demographics

First Name (and all middle names)

Last Name

Gender

Nationality

Date of Birth

Address

Email Address

Contact Numbers

Qualifications (Basic)

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

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)

Have you ever been suspended, restricted, or revoked of your licensure...

YES NO

Have you ever been denied an application for licensure...

YES NO

Have you ever been found guilty of professional misconduct...

YES NO

Do you have a health condition that may impact on the safe performance of your duties...

YES NO

Are you currently or have you been under investigation...

YES NO

Please answer YES or NO to the following questions