Medical Exam I-693: Complete Guide

Important: This information is provided for educational purposes only and does not constitute legal advice.

⚠️ Most common mistake: opening the sealed I-693 envelope or missing I-693 from the package — your entire application will be rejected.

Last Updated: 2025-05-25 | Updated for USCIS 2025 Edition

Information is based on publicly available USCIS instructions. Always verify current requirements on uscis.gov.

What is a Civil Surgeon

A Civil Surgeon is a licensed physician in the United States who has received official authorization from U.S. Citizenship and Immigration Services (USCIS) to conduct immigration medical examinations. Important: Your regular personal physician cannot perform this examination unless they have the special USCIS designation. The physician's role in the green card process: • Completing Form I-693: The doctor's main task is to conduct the examination and fill out the official Form I-693 (Report of Immigration Medical Examination and Vaccination Record). • Health screening: The doctor reviews your medical history, conducts a physical examination, and tests for communicable diseases of public health significance (tuberculosis, syphilis, gonorrhea). • Vaccination review: They compare your vaccination records against U.S. requirements and administer any missing vaccines.

New 2025 Requirement

As of February 10, 2025, Form I-693 is required at the time of filing I-485. You can no longer submit it later or at the interview (with limited exceptions).

Step 1: Find a Civil Surgeon

Find a civil surgeon on the official USCIS website: https://www.uscis.gov/tools/find-a-civil-surgeon Only civil surgeons are authorized to conduct immigration medical exams. Regular doctors cannot complete Form I-693. How the process works with a Civil Surgeon: 1. Find a doctor: Locate an accredited physician in your area using the official USCIS Find a Civil Surgeon tool only. 2. Bring documents: Bring a printed Form I-693, identification, and all vaccination records to your appointment. 3. Receive results: After the examination and lab results, the doctor will give you a sealed envelope containing Form I-693. 4. Critical rule: You are not allowed to open this envelope. USCIS will not accept an opened envelope. It must be sent to USCIS with Form I-485 (adjustment of status) or submitted later upon request (RFE). Note: If you are obtaining an immigrant visa outside the United States through a consulate, the examination is conducted not by a civil surgeon but by another approved physician — a panel physician. Tip: Check reviews and compare prices — costs can vary 2-3x between providers.

Step 2: Schedule Appointment

Schedule in advance: • Typical wait time: 2-4 weeks • Some vaccines require multiple visits • Plan according to your I-485 filing timeline Important: Do not schedule too early — wait until you are ready to file I-485.

Step 3: Prepare for Appointment

Bring to the appointment: • Passport or ID • Vaccination records • List of current medications • Information about chronic conditions If you do not remember your vaccinations — civil surgeon can do blood tests to check immunity (titers).

Step 4: The Medical Exam

Civil surgeon will conduct: • Physical examination • Vaccination records review • TB screening (skin test or blood test) • Syphilis test (age 15+) • Gonorrhea test (age 15+) • Mental health evaluation • Drug history review If additional vaccines are needed — they can be administered immediately or scheduled separately.

Step 5: Sealed Envelope

After the exam, the civil surgeon will: • Complete Form I-693 • Seal it in an envelope • Sign the envelope ⚠️ CRITICAL: DO NOT OPEN the envelope! Include it sealed with your I-485 package. If the envelope is opened, damaged, or the seal is broken — Form I-693 will not be accepted and your entire I-485 application will be rejected. Note: If you are obtaining an immigrant visa outside the United States through a consulate, the examination is conducted not by a civil surgeon but by another approved physician — a panel physician. In this case, the procedure may differ.

Required Vaccinations

Civil surgeon will review your vaccination records and administer any missing vaccines: • MMR (measles, mumps, rubella) • Varicella (chickenpox) • Tdap (tetanus, diphtheria, pertussis) • Influenza (seasonal flu) • COVID-19 — requirement removed January 22, 2025 Bring your vaccination records to the appointment to save time and money.

Medical Exam Cost

Medical exam costs vary: • Average cost: $200-400 • Range: $100-500 • Insurance typically does not cover (this is an immigration exam, not medical necessity) What is included: • Physical examination • Vaccination review • TB test (tuberculosis) • Syphilis test (age 15+) • Gonorrhea test (age 15+) • Mental health evaluation • Form I-693 completion Additional vaccines will increase the cost.

I-693 Validity Period

Important 2025 changes: • Form I-693 does not expire for I-485 purposes if signed by the civil surgeon after November 1, 2023 • As of June 11, 2025: I-693 is tied to a specific I-485 application — if I-485 is denied, the medical exam cannot be reused Tip: Do not get the medical exam too early — wait until you are ready to file I-485.

Online Filing (Employment-Based Only)

If filing I-485 online (employment-based categories only): • The I-693 envelope must be OPENED • Upload PDF of all pages of Form I-693 • Including pages completed by the civil surgeon For family-based mail filing — the envelope must remain SEALED.

Common I-693 Mistakes

Avoid these critical errors: ❌ Opening the sealed I-693 envelope before mailing ❌ Missing I-693 from the document package ❌ Using a regular doctor instead of civil surgeon ❌ Using an outdated I-693 form ❌ Expired TB test or other tests ✅ Correct approach: • Find a civil surgeon at uscis.gov/civil-surgeons • Schedule in advance (2-4 weeks) • Bring vaccination records • DO NOT OPEN the envelope (for mail filing) • Check doctor signature and date

Help with I-693 Preparation

We explain the medical exam process and help you understand what to expect. Included in our I-485 document preparation service.

Get Started