Who Needs an Immigration Medical Exam
If you are applying for a green card while living in the United States—a process called “adjustment of status” (Form I-485)—you must complete the immigration medical exam. This applies to most green card categories, including family-based, employment-based, and diversity visa applicants.
Children and elderly applicants go through the same exam, but the vaccination requirements are age-adjusted. A two-year-old will not receive the same vaccines as a 40-year-old adult.
A few categories are exempt. Certain diplomats and special immigrants do not need the exam. Asylee and refugee applicants who already received an overseas medical exam may only need a follow-up screening rather than a full exam. If you are unsure whether the exemption applies to you, check with your immigration attorney or review the instructions on the USCIS website for Form I-485.
How to Find a USCIS-Designated Civil Surgeon Near You
A civil surgeon is a licensed U.S. physician who holds a special designation from USCIS. Only designated civil surgeons can perform the immigration medical exam and complete Form I-693. Your regular doctor, urgent care clinic, or emergency room cannot do this unless they hold that specific designation.
There are about 7,500 designated civil surgeons across the United States. When choosing a doctor, look for offices that keep vaccines on-site (saves you a separate pharmacy trip and extra cost), speak your language, provide clear pricing before your visit, and offer a fast turnaround on Form I-693 completion. If you are more comfortable in a language other than English, many civil surgeons offer appointments in Spanish, Chinese, Korean, Hindi, and other languages.
Search our directory of 7,500+ civil surgeons to find one near you, compare prices, and read reviews from other applicants.
How Much Does the Immigration Medical Exam Cost?
There is no standard price. What you pay depends on your location, the civil surgeon’s office, and how many vaccines you need. Here is a breakdown of typical costs:
| Component | Typical Range | Notes |
|---|---|---|
| Exam fee (physical + I-693) | $200–$500 | Varies by city and practice |
| Vaccinations (per vaccine) | $50–$150 each | Only missing vaccines required |
| TB blood test (QuantiFERON) | $50–$150 | Included at some offices |
| Chest X-ray (if TB positive) | $75–$200 | Only if TB test is positive |
| Total typical range | $300–$1,000+ | Depends on vaccination needs |
Most health insurance does not cover this exam. Some community health centers and larger practices offer lower fees or payment plans. Call ahead to confirm accepted payment methods.
Compare civil surgeon prices in your area
What to Bring to Your Appointment
- Government-issued photo ID (passport, driver’s license, or state ID)
- Vaccination records — any language, any country (translations are helpful but not required)
- Form I-693 with Parts 1–4 filled out, NOT signed (the doctor must watch you sign)
- Payment (cash or card — confirm with the office)
- Previous medical records (TB test results, chest X-rays, bloodwork)
- List of current medications
- Contact info for your immigration attorney (optional but helpful)
What Happens During the Immigration Medical Exam
Medical History Review
The doctor asks about past illnesses, hospitalizations, mental health history, substance use, and current medications. Be honest — the civil surgeon is documenting your health for USCIS, not reporting to immigration enforcement. Inconsistencies between your answers and your medical records can cause delays.
Physical Examination
The doctor checks your blood pressure, heart rate, and temperature, then examines your heart, lungs, eyes, ears, skin, lymph nodes, and abdomen. The physical takes about 30 minutes.
What they do NOT do: there are no invasive procedures, no gynecological exam, and no rectal exam. Wear a short-sleeved shirt to make the TB test and blood draw easier.
TB Screening
Every applicant must be screened for tuberculosis. You can choose between two methods:
| PPD Skin Test | QuantiFERON Blood Test | |
|---|---|---|
| Method | Injection under forearm skin | Single blood draw |
| Return visit | Yes — 48–72 hours | No |
| Results | 48–72 hours | 2–7 business days |
| BCG false positive? | Yes, common | No |
| Cost | Usually included | $50–$150 extra |
| Best for | People without BCG history | People who received BCG vaccine |
If either test is positive, a chest X-ray is required. A positive TB test does not mean you have tuberculosis — it is very common in people who received the BCG vaccine as children, which is standard in many countries outside the U.S.
HIV testing has NOT been required since January 2010. It is not part of the immigration medical exam.
Vaccination Assessment
The doctor reviews your records against the USCIS-required vaccination list. Missing vaccines are given on-site if available. Blood titer tests can prove immunity for some vaccines (MMR, hepatitis B, varicella) without revaccination, which can save you money.
Required Vaccinations for the Immigration Medical Exam
USCIS requires the following age-appropriate vaccinations for the immigration medical exam:
| Vaccine | Protects Against | Notes |
|---|---|---|
| MMR | Measles, Mumps, Rubella | 2 doses required; blood titer accepted as proof of immunity |
| Tdap | Tetanus, Diphtheria, Pertussis | 1 dose if not current |
| Polio (IPV) | Polio | Series completion varies by age |
| Hepatitis A | Hepatitis A | 2-dose series |
| Hepatitis B | Hepatitis B | 3-dose series; blood titer accepted |
| Varicella | Chickenpox | 2 doses; titer or documented disease history accepted |
| Influenza | Seasonal flu | Required during flu season (October–March) |
| Meningococcal | Meningococcal disease | Primarily ages 11–18 |
| Pneumococcal | Pneumococcal disease | Age-dependent; primarily young children and older adults |
Not everyone needs every vaccine — requirements are age-adjusted. If you had certain diseases (chickenpox, measles), a blood titer test can confirm immunity.
Looking for a civil surgeon with vaccines on-site? Search our directory
Understanding Form I-693
Form I-693 is the official “Report of Immigration Medical Examination and Vaccination Record.” It is the document USCIS uses to determine whether you meet the medical requirements for a green card.
You fill out Parts 1 through 4 of the form before your appointment. The civil surgeon completes the rest after performing the exam and reviewing your test results.
You must sign the form in front of the civil surgeon. Forms that are pre-signed at home will be rejected by USCIS.
After the doctor completes and signs Form I-693, they seal it in an envelope.
Warning: Do NOT open the sealed envelope. USCIS rejects forms with broken or tampered seals, and you would have to redo the entire exam at your own expense. Hand it directly to your attorney or include it unopened with your I-485.
Validity: Form I-693 is valid while the underlying application remains pending (per USCIS policy update, June 2025). Forms signed before November 1, 2023 are valid for two years from the signature date.
Common rejection reasons: broken seal, pre-signed form, expired form, or exam performed by a non-designated doctor.
Medical Conditions and Inadmissibility
Class A Conditions (Grounds for Inadmissibility)
Class A conditions are findings that can make you inadmissible under immigration law. These include communicable diseases of public health significance (active tuberculosis, untreated syphilis, untreated gonorrhea), physical or mental disorders with associated harmful behavior, and drug abuse or addiction. If you have a history of substance use and are in treatment or recovery, talk to your immigration attorney before the exam—there are paths forward.
A Class A finding does NOT automatically end your application. Waivers are available for most Class A conditions. If this applies to you, consult an immigration attorney before making any decisions about your case. Many of these situations are resolved with treatment and the proper documentation.
Class B Conditions (No Effect on Admissibility)
Class B conditions are physical or mental conditions that the civil surgeon documents on the form but that do NOT affect your admissibility. Examples include controlled diabetes, treated depression, or a past surgery.
These are noted on Form I-693 but do not affect whether you receive your green card. USCIS does not hold Class B findings against you.
How Long Does the Immigration Medical Exam Take?
The entire process from scheduling to receiving your sealed Form I-693 typically takes about three weeks. Here is a typical timeline:
Day 1–3
Find a civil surgeon, call to schedule your appointment.
Day 3–14
Wait for your appointment. Typical wait is 2–3 weeks; faster in big cities with more civil surgeons.
Day 14
First visit — physical exam, TB test, vaccinations administered.
Day 16–17
Return for TB skin test reading (if you chose the PPD skin test).
Day 17–21
Lab results received by the civil surgeon's office.
Day 21
Second visit — receive your sealed Form I-693.
Day 21+
Submit the sealed form with your I-485 application.
Same-day clinics using QuantiFERON blood tests can compress this to 1–2 visits over 3–7 days.
Ready to schedule? Find a civil surgeon near you