Immigration Medical Exam: What to Expect
Almost everyone applying for a green card from inside the U.S. needs an immigration medical exam, recorded on Form I-693 and signed by a USCIS-designated civil surgeon. Here is the whole process — the appointment, required vaccines, cost, and how long the form stays valid under the current 2025 rules.
At a glance
- Who signs itUSCIS civil surgeon only
- Typical length30–60 minutes
- Base exam fee$200–$500
- COVID-19 vaccineNo longer required
- Form validityWhile your case is pending
Who needs an immigration medical exam
You will generally need one if you are:
- Filing Form I-485 to adjust status to lawful permanent resident
- A refugee, within one year of arrival
- An asylee applying for adjustment of status
- Any applicant USCIS asks to prove they are not inadmissible on health grounds
Applying from outside the U.S.?
You do not see a civil surgeon. You see a panel physician authorized by the U.S. Department of State in your processing country. The forms and process are different.
Only a designated civil surgeon can complete Form I-693
This is the most common misunderstanding, and it costs people time. Your family doctor cannot sign Form I-693 — not because they aren’t qualified, but because “civil surgeon” is a specific designation USCIS grants to individual doctors. Many walk-in and urgent care clinics do not hold it. Confirm before you book.
Find a designated civil surgeon near youWhat happens during the exam
Most appointments run 30 to 60 minutes — longer if you need catch-up vaccines or extra testing.
Medical history review
Your history, current medications, past hospitalizations, and any communicable disease history.
Physical examination
A general physical — eyes, ears, nose, throat, heart, lungs, abdomen, skin and extremities.
Tuberculosis screening
A TB blood test (IGRA) for applicants aged 2+. The old skin test is no longer accepted.
Blood test for syphilis
Required for applicants aged 15 and older.
Vaccination review
Your records are checked against the CDC schedule and any missing vaccines are given.
Form sealed & signed
The civil surgeon seals Form I-693 in an envelope. Do not open it — submit it sealed.
Never open the sealed envelope. A form that reaches USCIS in an opened envelope can be rejected. Submit it exactly as you received it.
Required vaccinations
The CDC sets the list and USCIS follows it. Requirements are age-dependent — no applicant needs every vaccine. Your civil surgeon decides which apply to you.
COVID-19 is no longer required
As of 22 January 2025, USCIS waived the COVID-19 vaccination requirement, and the CDC removed it from the Technical Instructions in March 2025. You do not need to show proof, and USCIS will not issue an RFE or deny an application over it. Many sites still list it as required — it isn’t.
If you can’t find your records
- Titers — a blood test that checks if you’re already immune
- Re-vaccination — safe to repeat most vaccines
- Partial series — usually only the first dose is needed before signing
Exemptions
A vaccine can be marked not required if it is not age-appropriate, medically contraindicated, or unavailable. A religious or moral waiver is filed on Form I-601. Your civil surgeon documents the reason on the form.
Cost of the immigration medical exam
There is no fixed government fee. Civil surgeons set their own prices, and the total depends mostly on how many vaccines you still need.
| Item | Typical cost |
|---|---|
| Civil surgeon exam fee | $200 – $500 |
| TB blood test (IGRA) | $50 – $150 |
| Missing vaccines, per dose | $30 – $120 |
| Vaccination record retrieval | $0 – $50 |
| Reissuing a lost sealed form | Varies by practice |
Insurance almost never covers an immigration medical exam, since it is an administrative requirement, not treatment. Two ways to save: get vaccines at a pharmacy beforehand (often covered as preventive care), and ask each practice for an all-inclusive quote.
How long Form I-693 stays valid
This rule changed twice recently — and it’s where most outdated advice does real damage.
Signed on or after 1 Nov 2023
Valid only for the application you filed it with, and only while that case is pending. If your I-485 is denied or withdrawn, the exam dies with it — you start over. In force since 11 June 2025, replacing the withdrawn 2024 “never expires” policy still quoted on many sites.
Signed before 1 Nov 2023
The earlier rule applies — the form keeps its value for two years from the date of the civil surgeon’s signature.
USCIS now expects Form I-693 to be submitted together with your Form I-485, not sent later. Filing without it risks rejection. Officers also keep discretion to request a new exam if your medical situation may have changed.
Common reasons applications get delayed
What to bring to your appointment
- Government-issued photo ID (passport, driver’s license, or state ID)
- Vaccination and immunization records, however incomplete
- A list of medications you take regularly
- Your USCIS receipt notice, if you have one
- Records of any prior TB testing or treatment, including chest X-rays
- Form I-693 if you already have it — most offices can provide a copy
- Payment (confirm accepted methods when booking)
Not near a civil surgeon?
Start with a virtual pre-consult. We review your documents and vaccination records in advance so the in-person visit is short. It does not replace the exam — a civil surgeon must still examine you in person and sign the form.
Start a virtual pre-consultFrequently asked questions
Find a civil surgeon near you
Browse USCIS-designated civil surgeons by state and compare cost, languages and availability.
This page is general information reflecting USCIS and CDC guidance as of July 2026 — not medical or legal advice, and not a substitute for guidance from a licensed physician or immigration attorney about your own case. Requirements vary by applicant and change over time; always confirm current rules with USCIS. USCISMD.com is an independent directory and is not affiliated with USCIS or any U.S. government agency.