Provisional Registration Form – The Medical Board of Trinidad and Tobago

How to use this form:

Complete the online form and upload your supporting documents below. You must also download the Provisional Registration Form below, print and sign it, and bring it to the MBTT office (downloading your pre-filled PDF is optional).

📄 Download Pre-filled Application PDF (Optional)

After filling in details below, click here to download a printable copy of your pre-filled details.

Demographics

First Name (and all middle names)

Last Name

Gender

Nationality

Date of Birth

Contact Numbers

Email Address

Residential Address

Qualifications (Basic Medical)

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

Supporting Documents

Instructions for completing Application forms for Provisional Registration.

The Applicant must fill out the front page up to and including the Signature and Date, and the back of the form up to and including Signature and Date.
The Certificate of Good Character (inner left page) must be completed by a Physician who is already fully registered to practice medicine in Trinidad & Tobago.
The Certificate of Identity (inner right page) must be completed by another Physician who is already fully registered to practice medicine in Trinidad & Tobago.
Two passport size photographs need to be submitted. The Physician who completed the Certificate of Identity must also insert the italicized sentence (refer to the application form) at the back of each photograph. The backs of the photographs must be signed and dated by the same physician.
Applications must also be accompanied by certified photocopies of some form of photographic identification (e.g., Passport, National ID, Driver’s Permit).

Identity Proof *

Upload passport, driver's licence or national ID card

Passport-sized Photo *

Upload clear recent photo, JPG or PNG

Doc 1 of 1 Provisional Registration Form *

Download the Provisional Registration form below, print it, fill in (complete all fields and signatures), bring physical copy to MBTT's office.

Download Provisional Registration Form (PDF)

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

Please indicate YES or NO to the following questions (1–5)

If YES to any question, you must provide additional details below.

1. Have you ever been suspended, restricted, or revoked of your licensure, registration, permit or any other authority to practice medicine in another jurisdiction?

YES NO

2. Have you ever been denied an application for licensure, registration, permit or any other authority to practice medicine in another jurisdiction?

YES NO

3. Have you ever been found guilty of professional misconduct, conduct unbecoming of a physician, or any similar charge in another jurisdiction?

YES NO

4. Do you have a health condition that may impact on the safe performance of your duties as a medical practitioner?

YES NO

5. Are you currently or have you been under investigation by any Medical Board, Council or other regulatory body?

YES NO

Help

Instructions for completing Application forms for Provisional Registration.

Please indicate YES or NO to the following questions (1–5)