How to Prepare for Immigration Medical Exam?

Every green card applicant filing Form I 485 must complete an immigration medical exam before USCIS will approve their adjustment of status application. A USCIS designated civil surgeon performs the exam, screens for communicable diseases, reviews your vaccination history, and completes Form I 693, the official medical report that goes with your application. Most applicants who prepare properly finish the process in a single visit, while those who arrive without the right documents or records face multiple appointments that add weeks and extra costs.

This guide gives you a complete checklist of what to do before, during, and after your immigration medical exam so nothing slows down your green card timeline.

What Is the Immigration Medical Exam and Who Needs It?

The immigration medical exam is a mandatory health screening required by USCIS for every applicant seeking a green card through adjustment of status inside the United States. The purpose of the exam is to confirm that you meet the health standards set by the CDC and U.S. immigration law under Section 212(a) of the Immigration and Nationality Act. Without a completed Form I 693 from a designated civil surgeon, USCIS will not process your I 485 application.

The exam covers a physical evaluation, a mental health screening, a substance use assessment, and lab tests for tuberculosis, syphilis, and gonorrhea. Your vaccination records are reviewed against the CDC required list for your age group. The civil surgeon documents all findings on Form I 693, classifies any medical conditions as Class A or Class B, and seals the form in an envelope for submission. For a detailed overview, read our blog on Immigration Physical Exam.

Only a USCIS designated civil surgeon can perform this exam and sign Form I 693. A regular physician or urgent care clinic does not have the authority to complete immigration medical forms. You can find a designated civil surgeon near you using the Find a Doctor tool on the USCIS website. To learn more about the designation, read our detailed resource on what a civil surgeon is.

How to Prepare for Your Immigration Medical Exam Step by Step

Follow these steps before your appointment to make sure you arrive fully prepared and avoid delays or extra visits.

Step 1: Schedule Your Appointment Early

Do not wait until the last minute to book your appointment. Some vaccine series like hepatitis B require three doses spread over several months, and you cannot submit an incomplete Form I 693. Schedule the exam well in advance of your I 485 filing date so there is time to complete any required follow up doses.

Call the civil surgeon’s office before booking to ask about the total cost, payment methods, and how many visits the process takes. The total cost ranges from $200 to $500 depending on the provider, lab fees, and vaccination needs. Most health insurance plans do not cover this exam.

Step 2: Gather All Required Documents

You need a valid government issued photo ID such as a passport or state driver’s license. You also need your I 94 arrival record, your A number if one has been assigned, and your I 485 receipt notice so the civil surgeon can confirm your case details. Applicants who completed an exam abroad should bring those records as well.

A missing document is the top reason applicants need extra visits. One forgotten item can push your timeline back by weeks. Review every item on this list the night before your appointment so you arrive with everything the doctor needs.

Step 3: Collect Your Vaccination Records

Your vaccination history is the most important document for the immigration medical exam. Locate every immunization card, school health record, or medical file from your home country that shows the vaccines you received. The civil surgeon checks each record against the CDC required panel for your age group, and complete records mean no extra blood draws and no catch up doses.

Adult applicants generally need proof of MMR, Tdap, varicella, hepatitis A, hepatitis B, polio, and seasonal influenza vaccines. As of January 2025, the COVID 19 vaccine is no longer required.

Step 4: Complete Part 1 of Form I 693

Download Form I 693 from the USCIS website and fill out Part 1 before your appointment. This section asks for your legal name, date of birth, A number, country of birth, and mailing address. The civil surgeon completes all remaining sections during and after the exam, so arriving with Part 1 done saves time at the office.

Part 1 left blank or completed incorrectly wastes time that the examining doctor could spend on the actual evaluation. For a section by section walkthrough of the entire form, read our guide on Form I 693 that highlight what It Is and how to fill It out.

Step 5: Know What to Expect on Exam Day

The civil surgeon performs a physical evaluation covering your eyes, ears, heart, lungs, skin, and lymph nodes. A mental health screening and substance use assessment are also standard. Blood is drawn for three mandatory lab tests: a TB blood test, a syphilis test, and a gonorrhea test.

There is no fasting requirement for the immigration medical exam, so eat and drink normally before your appointment. Wear comfortable clothing with short sleeves for easy access during the physical evaluation and blood draw.

What Happens After the Immigration Medical Exam?

Once lab results are back and your vaccination status is verified, the civil surgeon completes the remaining sections of Form I 693, signs the certification, and seals the form in an envelope. Do not open this envelope. USCIS rejects any form that shows signs of tampering, and you will need to redo the entire exam at your own expense if the seal is broken.

You must submit the sealed Form I 693 with your I 485 application. Plan your USCIS medical exam appointment close to your filing date so the form does not expire before USCIS reviews your case. Lab results typically return within three to five business days, so most applicants receive their sealed form within one to two weeks of the initial visit.

At Prime Healthcare of Cypress, we provide immigration physicals in Cypress and our civil surgeon handles the full process from the physical evaluation and lab work to the vaccination review and Form I 693 completion for your green card medical exam. Here is a comparison of how preparation affects your exam experience.

What to Do If Your Vaccination Records Are Missing?

Many applicants who received childhood vaccines in another country cannot locate their original immunization records. The civil surgeon can order titer blood tests to measure antibody levels and confirm immunity without paper documentation. Titers are accepted by USCIS as valid proof of past vaccination on Form I 693.

If titer results show no immunity to a specific disease, you will need catch up doses of that vaccine before the form can be completed. Some vaccines can be given the same day as the exam, while others require a waiting period between doses.

Applicants who know their records are missing should schedule the exam as early as possible. Titer testing adds time and cost, and any required revaccination can stretch the process by several weeks.

Frequently Asked Questions