The Immigration Medical Exam: A Plain-English Guide
Quick answer: The immigration medical exam is a required checkup with a government-approved doctor called a civil surgeon (or a panel physician if you're overseas) that confirms you don't have a health condition that blocks your green card or visa. It covers a physical exam, a review of your vaccine records, a mental health screening, and sometimes blood or TB tests. You'll get the results in a sealed Form I-693, which you either submit with your green card application or bring to your interview.
Key takeaways
- The exam must be done by a USCIS-designated civil surgeon if you're applying inside the U.S., or a State Department panel physician if you're applying from abroad — regular doctors and urgent care clinics cannot sign the form.
- Form I-693 results are typically valid for two years from the date the civil surgeon signs it, according to USCIS policy, so timing your exam close to your filing date matters.
- Required vaccines are set by the Centers for Disease Control and Prevention (CDC) and include things like MMR, Tdap, polio, and varicella, though a civil surgeon can grant a waiver if a vaccine isn't medically appropriate or violates your religious beliefs.
- Costs aren't set by USCIS, so prices vary by clinic — expect a range that can run into several hundred dollars depending on your location and how many vaccines you need.
Step 1: Confirm Whether You Actually Need the Exam Right Now
Not everyone needs this exam at the same point in their case. If you're applying for a green card through adjustment of status (Form I-485) while inside the U.S., you'll generally need it before or with that filing. If you're going through consular processing from abroad, the panel physician exam happens closer to your visa interview.
Some visa categories skip it entirely — most nonimmigrant visas (tourist, student, most work visas) don't require a medical exam. It's mainly required for green card applicants and certain other categories USCIS specifies.
If you're not sure where this fits into your overall filing, our guide on what is an immigration filing checklist and why it matters breaks down which documents pair with which forms, so you're not guessing at what goes in the envelope.
Step 2: Find and Book a Civil Surgeon (Not Your Regular Doctor)
Your family doctor cannot fill out Form I-693 unless they're specifically designated by USCIS as a civil surgeon. You can find a list of designated civil surgeons near you through the official USCIS civil surgeon locator on the USCIS website — search by ZIP code, and call ahead to confirm they're still accepting new patients and doing full exams (not just partial services).
A few things worth checking before you book:
- Ask what's included in the quoted price. Some clinics charge separately for the exam, vaccines, and any blood or TB testing.
- Ask how they handle vaccine records. Bring anything you have — a childhood immunization card, a school record, or prior medical files — so the civil surgeon doesn't have to re-administer shots you've already had.
- Ask about wait times. Some civil surgeons book out several weeks, especially in high-immigrant-population areas.
- Confirm they accept walk-ins for follow-up TB testing, since some tests require a second visit 48–72 hours later to read results.
If you're overseas and going through a U.S. embassy or consulate, the National Visa Center or the embassy itself will typically direct you to a specific panel physician on an approved list — this isn't optional and isn't the same list as the domestic civil surgeon directory.
Step 3: Gather Your Records Before the Appointment
Showing up prepared saves you a second appointment and, often, extra money. Bring anything that documents your medical and vaccination history, even if it's incomplete.
Checklist — what to bring to your civil surgeon appointment:
- Bring a government-issued photo ID and your passport
- Bring two passport-style photos if your civil surgeon requests them
- Bring your Form I-693 confirmation or appointment notice, if you have one
- Bring any vaccination records you can find — childhood shot records, school immunization forms, or prior doctor's notes
- Bring a list of current medications and dosages
- Bring records of any past tuberculosis test results or chest X-rays
- Bring your I-797 receipt notice for your pending case, if you have one, so the civil surgeon can confirm your filing category
Don't skip this: never let anyone open the sealed envelope containing your I-693 results except USCIS or, if applicable, the consular officer. A civil surgeon seals the form before handing it to you, and USCIS instructs applicants not to break that seal — an opened envelope can cause delays or rejection of the form.
Step 4: Know What Actually Happens During the Exam
The exam itself is fairly routine and usually takes under an hour, though vaccine catch-up or TB follow-up can stretch that over multiple visits. Expect these components:
- A physical exam — height, weight, vision, hearing, and a general health check.
- A review of your vaccination history against the CDC's required vaccination list for immigration purposes.
- A mental health and substance use screening, mostly through questions, to check for conditions that could pose a public health or safety concern.
- A tuberculosis (TB) test, required for most applicants ages 2 and older — usually a blood test (IGRA) rather than the older skin test, per current CDC guidance for civil surgeons.
- A blood test for syphilis, required in some cases depending on age and category.
- Additional tests if the civil surgeon flags something during the physical exam, like a chest X-ray if your TB test comes back positive.
None of this is meant to be adversarial. Civil surgeons do this exam constantly, and their job is to document your health status accurately, not to find a reason to deny your case.
Step 5: Understand the Vaccine Requirement — and What Happens If You're Missing Some
You don't need every vaccine before your appointment — the civil surgeon will vaccinate you on the spot for anything you're missing, as part of the same visit. The CDC sets the required vaccination list for immigration medical exams, and it's periodically updated, so confirm the current list with your civil surgeon or the CDC's official guidance rather than relying on an old list you found online.
Commonly required vaccines include:
| Vaccine | Typically required for |
|---|---|
| MMR (Measles, Mumps, Rubella) | All applicants within the applicable age range |
| Tdap (Tetanus, Diphtheria, Pertussis) | All applicants |
| Polio | All applicants |
| Varicella (Chickenpox) | Applicants without documented immunity |
| Hepatitis A and B | Applicants within the applicable age range |
| COVID-19 | Per current CDC guidance — confirm status with your civil surgeon |
If you're missing a vaccine, the civil surgeon administers it during the exam or documents a plan for you to complete the series afterward. You are not required to have completed every dose before the exam in every circumstance — USCIS allows the civil surgeon to note vaccines still in process, subject to current policy, so ask directly how your specific gaps will be handled.
Vaccine waivers exist for two main reasons:
- Medical contraindication — the civil surgeon determines a vaccine isn't appropriate for you, such as during pregnancy or due to an allergy.
- Religious or moral objection — you can request a waiver, but this typically requires a written statement and, in some cases, USCIS approval of a separate waiver request (Form I-601 in certain contexts). This isn't automatic, so ask your civil surgeon what documentation they need.
Step 6: Get the Sealed I-693 and File It With Your Case (or Bring It to Your Interview)
Once the exam and any required follow-up tests are complete, the civil surgeon signs Form I-693 and seals it in an envelope for you to submit. Per USCIS guidance, the completed I-693 is generally valid for two years from the date it's signed, which matters if your case takes a while to process — file it too early relative to your interview date and it could expire before USCIS reviews it.
Two common paths from here:
- Adjustment of status applicants typically submit the sealed I-693 along with their Form I-485 packet, or in response to a Request for Evidence if USCIS asks for it later.
- Consular processing applicants bring the results (often handled directly between the panel physician and the consulate) to their visa interview.
If your case involves biometrics as a separate step, that's a different appointment with a different purpose — fingerprinting and photos, not a medical review. We cover that process in USCIS biometrics appointments: what to expect, step by step.
What to Do Next
Book your civil surgeon appointment as soon as you have a filing date in mind, since good clinics fill up and TB testing sometimes needs a second visit to read results. Bring every vaccine record you can dig up — it's the single biggest thing that speeds up the appointment and can lower your cost if you skip re-vaccination for shots you've already had.
If your green card case is already filed and you're wondering what happens after the medical exam and biometrics are behind you, tracking your case status can tell you exactly where things stand instead of guessing. MyCheck monitors your USCIS receipt number and sends a notification the moment your status changes, and its AI-generated checklists lay out exactly what's left for your specific visa type — so the medical exam is one clear step in a plan, not a mystery box.