What Happens at a Green Card Medical Exam, Step by Step

What the Exam Is, and Who Can Do It

If you file Form I-485 to adjust status inside the U.S., you need a medical exam by a USCIS-designated civil surgeon. The results go on Form I-693, Report of Immigration Medical Examination and Vaccination Record. The form is part of your green card filing. The visit is a required step, not an optional checkup, and it does not replace care from your own doctor.

Only doctors designated by USCIS can act as civil surgeons. Before you book, check the doctor with the USCIS "Find a Civil Surgeon" tool on uscis.gov. That tool is the official list, so it is the safest place to confirm a doctor. You can also compare civil surgeons by city on our site to see who is near you.

If you are outside the U.S. and going through consular processing, you see a panel physician chosen by the U.S. Department of State. That is a different process from the civil surgeon visit. The rest of this article covers the civil surgeon visit for people filing Form I-485 inside the U.S.

Step 1: Book the Visit and Ask About the Fee

Call the office or book online. Ask what the visit includes and what the fee covers. USCIS does not set the price. Each civil surgeon sets their own fee. Total cost commonly ranges from about $200 to $500 or more, depending on your city, the lab tests you need and how many vaccines you need. Health insurance often does not cover it, so plan to pay out of pocket.

Ask for the total before you book. The exam, the lab tests and any vaccines all feed into the final number. Knowing the total up front helps you compare offices fairly. Ask how long the office usually takes to return the completed form, so you can plan your filing date.

Watch your timing. The civil surgeon must sign Form I-693 no more than 60 days before you file Form I-485. Book early enough that the visit and the lab results fit inside that window.

Step 2: Bring the Right Papers

Come prepared. Missing records can slow the visit down or push your results back. Put everything in one folder before you go.

Vaccination records matter most. They show the civil surgeon which vaccines you already had, which can lower the number of shots you need. If you do not have records, ask the office what they accept before the visit.

Bring a government photo ID, such as your passport. The office uses it to confirm who you are. Bring payment the way the office asks when you book.

• A government photo ID, such as your passport.
• Your vaccination records.
• A list of medicines you take now.
• Past chest X-ray results, if you have them.
• Payment for the visit.

Step 3: The Visit Itself

The civil surgeon starts with your history. You go over your medical history and your vaccine history. You talk about the medicines you take now and any past health problems. Bring your records so this part moves faster.

Next comes a physical exam. The civil surgeon also does a mental health and substance use screening. Some of the visit is a conversation and some is a standard physical check. Answer honestly and completely. The civil surgeon is completing a government form, not treating you for a condition.

The physical exam is a standard check. It does not replace care from your own doctor. You can ask questions during the visit. If something in your history needs a closer look, the civil surgeon will tell you what comes next.

Step 4: The Lab Tests, by Age

Your age decides which tests you get. Not every applicant gets every test.

The tuberculosis test is a blood test, called an IGRA. The syphilis test is a blood test. The gonorrhea test is a urine test. A chest X-ray is not routine. The civil surgeon orders one only if the screening calls for it.

If you are not sure which tests apply to you, ask the office when you book. They can tell you what your visit will include based on your age.

• Tuberculosis blood test (IGRA) for applicants age 2 and older.
• Blood test for syphilis for applicants age 18 to 44.
• Urine test for gonorrhea for applicants age 18 to 24.
• Chest X-ray only if needed.

Step 5: Vaccines

Required vaccines depend on your age and your history. The list can include MMR, Tdap or Td, polio, hepatitis A and B, varicella, influenza during flu season, pneumococcal, Hib, meningococcal, rotavirus and others.

COVID-19 vaccination is no longer required for Form I-693. That change took effect January 22, 2025. If an older checklist or an old blog post told you otherwise, go by the current USCIS guidance.

Bring your vaccine records so the civil surgeon can see what you already had. Records can cut down on repeat shots. If your records are incomplete, ask the office how they handle it before the visit. The list looks long, but most adults need only a few.

Step 6: Results and the Sealed Envelope

Lab results usually take a few days to two weeks. The civil surgeon cannot complete Form I-693 until those results are back. Ask the office how they will tell you when the form is ready, by phone, email or pickup.

When the form is done, the civil surgeon gives you the completed I-693 in a sealed envelope. Do not open it. File the sealed envelope with your green card paperwork. If the envelope is damaged or opened, ask the office before you file.

Since December 2, 2024, USCIS generally requires Form I-693 to be submitted together with Form I-485. A filing without it can be rejected. The civil surgeon must sign the form no more than 60 days before you file. Rules and fees can change, so confirm the current requirements on uscis.gov before you file.