Every applicant for adjustment of status (Form I-485) must complete an immigration medical examination conducted by a USCIS-designated civil surgeon. The results are documented on Form I-693, Report of Immigration Medical Examination and Vaccination Record.
Key Facts
Cost: $200–$500 (varies by location). Validity: 2 years from the civil surgeon's signature. Must be completed by a USCIS-designated civil surgeon — regular doctors cannot perform the exam. Required vaccinations must be current.
What Is the Immigration Medical Exam?
The immigration medical exam (Form I-693) is a mandatory health screening required for all green card applicants in the United States. It must be conducted by a USCIS-designated civil surgeon — your regular doctor cannot perform it. The exam checks for communicable diseases, ensures you have required vaccinations, and screens for physical or mental conditions that could make you inadmissible. Without a completed I-693, your green card application will not be approved.
Finding a Civil Surgeon
Find a USCIS-designated civil surgeon at my.uscis.gov/findadoctor. Enter your ZIP code to see authorized doctors near you. Only these designated physicians can complete the I-693 — results from any other doctor will not be accepted. Call ahead to confirm pricing, appointment availability, and which vaccinations they stock (some may require you to get certain vaccines elsewhere).
What the Doctor Checks
The civil surgeon performs a physical examination including height, weight, blood pressure, vision, and hearing. They check for signs of communicable diseases of public health significance. Required lab tests include a tuberculosis screening (either a blood test like QuantiFERON or T-SPOT, or a tuberculin skin test — if positive, a chest X-ray is required), syphilis blood test (RPR or VDRL), and gonorrhea test. The doctor also reviews your mental health history and checks for substance abuse disorders.
Required Vaccinations
All green card applicants must have age-appropriate vaccinations from the CDC immunization schedule. For adults, this typically includes mumps, measles, rubella (MMR), polio (IPV), tetanus, diphtheria, pertussis (Tdap), hepatitis A, hepatitis B, varicella (chickenpox), influenza (seasonal), COVID-19, pneumococcal, meningococcal, and haemophilus influenzae type B (Hib). If you already received these vaccinations, bring your records — the civil surgeon will document them and you will not need duplicates. Missing vaccinations will be administered at the appointment (at additional cost).
Cost
The immigration medical exam typically costs $200 to $500 for the exam itself. Vaccinations are additional and can add $100 to $500+ if you need multiple shots. TB blood tests cost $50-$150 additional. Chest X-rays (if needed) add $75-$200. Total cost ranges from $200 (if you have all vaccination records) to $1,000+ (if you need multiple vaccinations and a chest X-ray). These costs are not covered by most insurance plans and are not reimbursable by USCIS. See our hidden costs of immigration breakdown.
What to Bring
Bring your passport or government-issued photo ID, vaccination records (any and all you have — even partial records help), your I-94 arrival/departure record, your USCIS receipt number (if available), your current prescription medications (in original bottles), health insurance card (some civil surgeons accept insurance for lab tests), and payment (cash, check, or card — confirm with the office). Wear short sleeves for blood draws and vaccinations.
I-693 Validity
The completed I-693 form is valid for 2 years from the date of the civil surgeon's signature. It must be submitted to USCIS within this window. If your I-485 processing takes longer than 2 years (common with current delays), you may need to redo the exam. Tip: time your medical exam strategically — not too early (risk of expiration) and not too late (risk of delaying your case).
The Sealed Envelope
The civil surgeon completes Form I-693, seals it in an envelope, and gives it to you. Do NOT open the sealed envelope. Submit it sealed with your I-485 application (or bring it to your USCIS interview if instructed). Opening the seal invalidates the form and you will need to redo the exam. If filing I-485 by mail, include the sealed I-693 in the package. If filing online, bring it to your biometrics or interview appointment.
What Can Go Wrong
Common issues include a positive TB test (requires chest X-ray; if the X-ray is clear, you are fine — prior BCG vaccination commonly causes false positives), missing vaccination records (you may need to get duplicate vaccinations), Class A conditions that make you inadmissible (active TB, certain STDs, substance abuse — some are waivable through an I-601 waiver), and expired I-693 (if your case processing exceeds 2 years). If you have a medical condition that concerns you, consult an immigration attorney before the exam.
Scheduling tip: Book your civil surgeon appointment 2-4 weeks before you plan to file I-485. This ensures the I-693 is fresh and gives you time to get any missing vaccinations. During Visa Bulletin advancement periods, civil surgeon appointments fill up fast — book early.
Last verified: April 2026 · Reviewed by USImmigrationLaw.Today editorial team.