Applying for a green card involves a lot of paperwork, background checks, and interviews. But there is one requirement that requires you to step away from your computer and visit a professional in person: the medical exam.
The I-693 form (officially titled the “Report of Immigration Medical Examination and Vaccination Record”) is a critical part of the Adjustment of Status process. It is the document that proves to the U.S. government that you are healthy enough to live in the United States and do not pose a public health risk.
Unlike other forms where you simply fill in your data and sign, the I-693 form requires a designated doctor—known as a “civil surgeon”—to complete the majority of the paperwork.
If you are feeling nervous about the medical exam, you aren’t alone. Many couples find this step confusing. Do you need a specific doctor? What vaccines are required in 2026? How much will it cost?
In this comprehensive guide, we will break down everything you need to know about the I-693 form, how to fill it out, and how to navigate the medical examination process smoothly.
ℹ️ 📋 Key Takeaways
- You cannot go to your family doctor. You must see a USCIS-designated “Civil Surgeon.”
- Do not open the envelope. The doctor will give you a sealed envelope at the end of the exam. If you open it, USCIS will reject it.
- Vaccines are mandatory. You must be up-to-date on specific vaccinations, or get them during your exam.
- The form has a validity period. In 2026, USCIS generally considers signed Forms I-693 to be valid for two years from the date the civil surgeon signed it.
- Applicant’s Role: You only fill out Part 1 of the I-693 form; the doctor fills out the rest.
What is the I-693 Form?
The I-693 form is a sealed report used by U.S. Citizenship and Immigration Services (USCIS) to determine if an applicant is “inadmissible” to the United States on public health grounds.
When you apply for a green card through marriage (Adjustment of Status), you are filing What is Form I-485? Adjustment of Status Explained Form I-485. As part of that application, you must prove that you do not have:
- A communicable disease of public health significance (like active Tuberculosis or Syphilis).
- A physical or mental disorder with associated harmful behavior.
- Drug abuse or addiction issues.
- Missing required vaccinations.
The I-693 is the evidence used to clear you of these concerns.
Who Needs to File Form I-693?
Generally, anyone applying for adjustment of status to become a permanent resident while currently inside the United States needs to file this form. This includes:
- Spouses of U.S. citizens applying for a marriage-based green card.
- Spouses of Green Card holders.
- Most other employment or family-based green card applicants.
The “Civil Surgeon” Rule: Finding the Right Doctor
This is the most common question we get at Greenbroad: “Can I just go to my regular doctor for my physical?”
The answer is no.
You must visit a doctor who has been authorized by USCIS to perform immigration medical exams. These doctors are called Civil Surgeons. If a doctor who is not on the designated list signs your I-693 form, your application will be denied or delayed.
How to Find a Civil Surgeon
USCIS provides an official tool to help you find authorized doctors in your area.
- Visit the official USCIS Find a Doctor page.
- Enter your zip code.
- You will see a list of doctors, their addresses, and phone numbers.
Pro Tip: Civil surgeons set their own prices. We strongly recommend calling 3 to 5 different doctors on the list to compare prices. We have seen prices range from $200 to over $800 for the exact same exam!
Step-by-Step: The Medical Exam Process
Navigating the medical exam doesn’t have to be stressful if you know what to expect. Here is the step-by-step workflow for handling the I-693 form.
Step 1: Download and Prepare the Form
You need the latest version of the I-693 form.
- What you do: Fill out Part 1 (Information About You) only. Do not sign it yet! You must sign it in front of the doctor.
- What Greenbroad does: If you use Greenbroad, we prepare Part 1 for you, ensuring your alien registration number (A-Number) and personal data match your other applications perfectly.
Step 2: Gather Your Medical Records
Before your appointment, find your vaccination records. This can save you money. If you have proof that you have already received the required vaccines (like MMR, Polio, or Tetanus), you won’t have to pay the civil surgeon to administer them again.
- Look for childhood vaccination booklets.
- Contact your current primary care physician for records.
- Check with your state’s health department.
Step 3: Attend the Appointment
Bring the following to your exam:
- Your passport or government-issued photo ID.
- Your vaccination records.
- The I-693 form (with Part 1 filled out).
- Payment (cash, card, or check, depending on the doctor’s policy).
- If you have a chronic medical condition, bring a report from your regular doctor detailing your diagnosis and treatment.
During the exam, the doctor will:
- Review your vaccination history.
- Conduct a physical examination (check eyes, ears, throat, heart, lungs, etc.).
- Test for Tuberculosis (TB) via a skin test or blood test.
- Test for Syphilis (blood test) and Gonorrhea (urine test).
- Ask questions about your medical history, including mental health and drug use.
Step 4: Follow-up (If needed)
If you need a TB skin test, you will have to return to the clinic 48-72 hours later to have the results read. If you are missing vaccines, the doctor will administer them (usually for an extra fee) or ask you to get them elsewhere and return with proof.
Step 5: Receive the Sealed Envelope
Once the doctor is satisfied that you meet all health requirements, they will complete the rest of the I-693 form, sign it, and place it in an envelope.
CRITICAL WARNING: The doctor will seal this envelope and usually stamp over the flap. DO NOT OPEN THIS ENVELOPE. If the seal is broken, USCIS will consider the form invalid, and you will have to pay for a new exam.
The doctor should give you a copy of the form for your personal records. If they don’t offer one, ask for it before they seal the original.
Vaccination Requirements for 2026
USCIS follows the guidelines set by the Centers for Disease Control and Prevention (CDC). As of 2026, you generally need to show proof of the following vaccinations (depending on your age):
- Mumps, Measles, Rubella (MMR)
- Polio
- Tetanus and Diphtheria Toxoids
- Pertussis
- Haemophilus influenzae type B
- Hepatitis B
- COVID-19 (Check current CDC guidelines as this evolves, but generally required for the series)
- Varicella (Chickenpox)
- Influenza (Required only during flu season, typically Oct 1 – March 31)
- Pneumococcal Pneumonia
- Rotavirus
- Hepatitis A
- Meningococcal
Note regarding waivers: If you oppose vaccinations due to sincere religious beliefs or moral convictions, you may apply for a waiver, but this adds significant complexity and time to your case. We recommend consulting a lawyer if you intend to seek a waiver.
How to Fill I-693 (Your Part)
While the doctor does the heavy lifting, you must ensure Part 1 is accurate. Errors here can cause Requests for Evidence (RFEs).
- Name: Use your legal name exactly as it appears on your passport and Form I-485.
- Address: Use your current physical address.
- Gender: Select the box that matches your current legal documentation.
- A-Number: If you have an Alien Registration Number (A-Number) from a previous work permit or visa application, include it. If you don’t have one, leave it blank.
- USCIS Online Account Number: Only include this if you have previously created an account online with USCIS.
🚀 😓 Feeling Overwhelmed?
Between finding a doctor, gathering records, and ensuring your forms match, the green card process is a lot to handle.
Greenbroad simplifies the journey. We prepare your entire application package—including the I-693 form—so all you have to do is print it and take it to your appointment. No guesswork, just clear instructions.
Costs and Insurance: What to Expect
One of the most frustrating parts of the I-693 guide is the cost.
- Average Cost: Most applicants pay between $200 and $600 for the exam.
- Insurance: Most U.S. health insurance plans do not cover immigration medical exams because they are considered “administrative” rather than “medically necessary.”
- Vaccine Costs: However, your insurance might cover the vaccinations if you go to your regular doctor or a pharmacy (like CVS or Walgreens) before your immigration exam.
Money-Saving Strategy:
- Check your records to see what vaccines you are missing.
- Go to a pharmacy or your regular doctor (using your insurance) to get those specific shots.
- Get printed proof of the new vaccines.
- Bring that proof to your Civil Surgeon.
This way, the Civil Surgeon only charges you for the exam, not the expensive vaccines.
When Should I Schedule My Exam?
Timing matters. In the past, there was a strict “60-day rule” regarding when the doctor signed the form versus when you filed.
However, current USCIS policy (as of 2024/2026) has made this easier. A properly completed Form I-693 signed by a civil surgeon is generally valid for two years from the date of the civil surgeon’s signature.
Option A: Filing concurrently (Recommended)
You can visit the doctor, get your sealed envelope, and mail it together in the same package with your The Ultimate Marriage Green Card Documents Checklist (2026 Update) Form I-485 application.
- Pro: It speeds up processing. USCIS has everything they need at once.
- Con: You have to pay the medical fee upfront.
Option B: Bring it to the interview
You can submit your application without the medical exam. USCIS will send you a deficiency notice (which is normal), and you will be instructed to bring the sealed I-693 to your green card interview.
- Pro: Delays the cost.
- Con: If USCIS decides to waive your interview (which happens frequently for straightforward marriage cases in 2026), they will issue a Request for Evidence (RFE) asking you to mail the medical form. This adds a step and delays your approval by weeks or months.
Greenbroad Recommendation: We generally recommend Option A. Submitting a complete package, including the medical exam, maximizes your chances of a smooth, interview-waived approval.
Common Mistakes to Avoid
Even smart applicants make simple errors that lead to rejection. Here is what to watch out for:
1. Using an Expired Form Edition USCIS updates forms frequently. If you use an edition of the I-693 form that is outdated, they will reject it. Always check the edition date at the bottom of the page. Note: Greenbroad always provides the most current edition automatically.
2. Signing Part 1 Too Early Do not sign Part 1 at home. You must wait until you are in the room with the Civil Surgeon so they can witness your signature.
3. Incomplete Vaccination Records If you forget your records, the doctor has no choice but to assume you haven’t been vaccinated. You will end up paying for shots you’ve already had.
4. “Shopping” for a Negative TB Result If you test positive for TB (even latent TB), do not just go to another doctor hoping for a different result. Civil Surgeons are required to report TB cases to the health department. Instead, work with the doctor to get the necessary chest X-ray to prove you are not contagious. A latent TB diagnosis usually does not prevent you from getting a green card, provided you follow medical advice.
Conclusion
The I-693 form is a mandatory health check that ensures the safety of the U.S. public, but it is also a significant milestone in your immigration journey. Once you have that sealed envelope in your hand, you are one step closer to your Green Card.
Remember the golden rules: find a designated Civil Surgeon, bring your vaccination records, and never open that envelope!
Make Your Green Card Journey Easier
The medical exam is just one piece of a very large puzzle. Between forms I-130, I-485, I-765, and I-131, the paperwork can feel endless.
Greenbroad is here to help. We are not a law firm, but a specialized service designed to help couples navigate the marriage-based green card process with confidence.
For a flat fee of $749, Greenbroad provides:
- Complete Application Preparation: We fill out every required form for you (including preparing your I-693 for the doctor).
- Customized Checklist: Know exactly what documents you need to gather.
- Assembly Instructions: We tell you exactly how to organize your package for USCIS.
- Peace of Mind: Our system automatically checks for common errors and inconsistencies.
Stop worrying about which box to check or which form edition to use. Let Greenbroad handle the paperwork so you can focus on your life together.
Get Started with Greenbroad Today
Disclaimer: This article provides general information and is not legal advice. Immigration rules and USCIS policies change frequently. If you have complex medical issues (such as a history of drug abuse or significant communicable diseases) or legal inadmissibility concerns, please consult with a qualified immigration attorney.