Every green card applicant meets Form I-693 eventually: the immigration medical exam that only a USCIS-designated civil surgeon can perform. It’s not your family doctor’s physical — it’s a defined checklist of vaccinations, tuberculosis screening, and communicable-disease tests, recorded in a sealed envelope you must not open. Handled early and correctly, it’s a routine errand; handled late or by the wrong doctor, it’s the classic Request-for-Evidence that stalls an otherwise clean case. Here’s exactly what happens and how to get it right the first time.
Current as of August 2, 2026. Medical and procedural requirements change — verify on USCIS.gov, and consult your attorney about timing for your case. Not legal or medical advice.
Who Performs It — and Why Your GP Can’t
Only a civil surgeon — a physician specifically designated by USCIS — can complete Form I-693 for applicants inside the US. (Applicants processing at consulates abroad see panel physicians designated by the State Department instead — same idea, different list.) Find one through the USCIS civil surgeon locator on uscis.gov; call two or three, because prices and appointment waits vary widely for the identical exam. Bring your vaccination records, a government ID, and any specialist letters about existing conditions.
What the Exam Actually Covers
| Component | What happens |
|---|---|
| Medical history & physical | Standard review — conditions, medications, hospitalizations, plus a physical examination |
| Tuberculosis screening | Blood test (IGRA) for applicants 2+ years old; positives trigger a chest X-ray and possible follow-up — the most common source of delay |
| Communicable disease tests | Screening for gonorrhea and syphilis (age-dependent) and review for other conditions of public-health significance |
| Vaccination review | Verification against the required list (MMR, Tdap, hepatitis, flu in season, and others by age) — missing shots are usually given on the spot |
| Drug/alcohol history | Screening questions; documented substance disorders can raise admissibility issues worth discussing with your attorney beforehand |
The Sealed-Envelope Ritual (Deadly Serious)
The civil surgeon completes the form, seals it in an envelope, and signs across the flap. USCIS will reject an opened envelope. Ask for a courtesy copy for your records before sealing — good surgeons offer automatically — and store the sealed original flat and safe until filing.
Timing: The Question Everyone Gets Wrong
- Best practice in 2026: submit the I-693 together with your I-485 package. USCIS has increasingly expected concurrent submission, and it eliminates the months-later RFE dance entirely.
- Validity rules have shifted repeatedly — current policy treats properly completed exams signed after late 2023 as not expiring for filing purposes, but this is exactly the kind of policy that moves; check the current USCIS I-693 page (or your attorney) rather than an old blog post — including this one, if it’s aged.
- Watch your priority date and plan backwards: when the Visa Bulletin shows your date approaching, book the exam ~4–6 weeks before your expected filing window — close enough to be fresh, early enough to absorb a TB follow-up.
Costs and Practicalities
There’s no government fee for the I-693 itself — you pay the civil surgeon directly, and prices are unregulated: commonly a few hundred dollars per adult, varying by city and by what vaccinations you end up needing. Ways to keep it down: bring complete vaccination records (missing documentation means repeat shots), get titers or shots through your regular insurance beforehand where possible, and price-shop the locator list — the exam is standardized; the markup isn’t.
Frequently Asked Questions
How much does the immigration medical exam cost?
It varies by civil surgeon — commonly a few hundred dollars per adult, plus any vaccinations you’re missing. Prices are unregulated, so call several offices from the USCIS locator.
Can my regular doctor do the I-693?
Only if they happen to be a USCIS-designated civil surgeon. Otherwise no — an exam by a non-designated physician is void for immigration purposes.
Should I file the I-693 with my I-485 or wait?
File together — it’s current best practice, avoids RFE delays, and USCIS has moved toward expecting it.
What if I test positive on the TB blood test?
A positive IGRA triggers a chest X-ray and evaluation; most cases resolve as latent/no-active-disease with documentation (sometimes treatment plans). It adds weeks — which is why the exam shouldn’t be left to the last minute.
Do I need every vaccine on the list?
You need each age-appropriate required vaccine or a documented contraindication/waiver. Bringing childhood records or blood-titer proof of immunity spares repeat shots.
What happens if I open the sealed envelope?
USCIS rejects it, and you’re paying for a new exam. Keep it sealed; keep the courtesy copy for reading.
Sources
- USCIS — Form I-693, Report of Immigration Medical Examination
- USCIS — Find a Civil Surgeon
- CDC — Technical Instructions for Civil Surgeons
Disclaimer: General information, not legal or medical advice. Requirements evolve — confirm current I-693 policy on USCIS.gov before your exam.
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