Green Card Medical Exam: Civil Surgeon, I-693 Form, and Costs (2026)

The green card medical exam is mandatory for every marriage-based green card applicant, whether applying inside the United States or through a U.S. embassy abroad. It is not a routine physical — it is a federally regulated examination conducted by a government-approved physician, using specific forms, screening for specific conditions, and following a strict vaccination protocol. Skipping it or going to the wrong doctor delays your case by months.

Who Performs the Exam: Civil Surgeons vs. Panel Physicians

The doctor who performs your exam depends on whether you are inside or outside the United States.

Inside the United States (adjustment of status): You must see a USCIS-designated civil surgeon. These are licensed physicians who have been specifically authorized by USCIS to conduct immigration medical examinations. Your regular primary care physician, even if excellent, is not eligible to complete the immigration forms unless they are on the USCIS civil surgeon list. The exam results are documented on Form I-693 (Medical Examination and Vaccination Record), which the civil surgeon completes, seals in an envelope, and gives to you unopened to submit with your I-485 packet.

Outside the United States (consular processing): You must see a DOS-designated panel physician — a doctor approved by the U.S. Department of State for your specific country. The panel physician completes the equivalent consular forms (DS-7794 and DS-2054). The results are typically sent directly to the embassy. A panel physician examination conducted in one country is generally not valid at an embassy in another country.

To find a civil surgeon inside the United States, use the civil surgeon locator on the USCIS website (uscis.gov/civil-surgeons). Filter by your zip code and verify the physician is currently active on the list. Call ahead — civil surgeon appointments are in demand and some offices have wait times of several weeks.

What the Immigration Medical Exam Includes

The exam covers:

Physical evaluation: The physician reviews your medical history, conducts a physical exam, and checks for communicable diseases of public health significance that would make you inadmissible. This includes screening for active tuberculosis (TB test required), syphilis, gonorrhea, and Hansen's disease.

Vaccination review: The physician reviews your vaccination history against the CDC-required immunization schedule for immigration purposes. Required vaccines include mumps, measles, rubella, polio, tetanus and diphtheria toxoids, pertussis, Haemophilus influenzae type B, and Hepatitis B. Note: the COVID-19 vaccination requirement was formally lifted for cases pending on or after January 20, 2025.

Mental health evaluation: The physician assesses for mental disorders associated with harmful behavior.

Substance use screening: The physician checks for drug abuse or addiction.

Immigration Medical Exam Cost in 2026

The U.S. government does not regulate what civil surgeons charge. Prices vary significantly by location, physician practice, and what vaccinations you need to receive during the appointment.

Typical ranges as of 2026:

• United States (civil surgeon): $250 to $650 for the base exam
• UK (panel physician, London): approximately £400 (around $480 USD)
• Mexico: approximately $375
• Colombia: approximately $180
• Vietnam: approximately $240

The base price covers the physical examination, the TB test reading (requiring a separate follow-up visit), the basic lab work (syphilis, gonorrhea), and completion of the I-693 form. What it does not include is the cost of any vaccinations you are missing. Each required vaccine that was not previously administered must be given at the appointment. Multiple missing vaccines can add several hundred dollars to the total cost.

Health insurance rarely covers immigration medical examinations. Plan to pay out of pocket.

Form I-693: Validity and Submission

As of a policy update effective November 2023, a properly completed and signed Form I-693 has indefinite validity for evidence purposes — the previous two-year expiration rule no longer applies. This means if you completed your civil surgeon exam but there was a delay in your case, the I-693 does not automatically expire and need to be redone.

However, USCIS retains discretion to order a new medical exam if there is reason to believe your health status has materially changed since the original examination.

Critical submission rules:

The civil surgeon must give you the I-693 in a sealed envelope. You submit it to USCIS in that sealed envelope, unopened. If you open the envelope for any reason — curiosity, reviewing it, photocopying it — the form is invalid and you need to go back to the civil surgeon for a new sealed envelope.

For adjustment of status cases, you can either submit the sealed I-693 with your initial I-485 packet or bring it to your USCIS interview. Submitting it with the initial packet is generally recommended to avoid having to carry the sealed envelope to the interview.

Vaccination Complications

Missing vaccinations are the most common reason a civil surgeon visit costs more than expected. If your vaccination history is incomplete — no childhood records, vaccines received in another country without documentation, or vaccines not on the CDC schedule for your birth year — you will receive them at the appointment.

To minimize costs, arrive with complete vaccination records. Contact your childhood doctor, local health department, or school records before your appointment. If you received vaccines abroad, bring the original documentation with an English translation.

Some vaccines require multiple doses on a schedule. If you need a series, the civil surgeon can provide a waiver or partial documentation for the initial I-693, with the understanding that the series will be completed. This is preferable to delaying filing for weeks waiting for a multi-dose vaccine series to conclude.

Inadmissibility on Medical Grounds

Most applicants pass the medical exam without issue. Conditions that can create problems:

Active tuberculosis: An active TB infection is a ground of inadmissibility. Latent TB (positive TB test but no active disease) is noted but is not itself a bar to the green card. Applicants with active TB must complete treatment before approval.

Missing vaccinations without waiver: Refusing required vaccinations without a documented religious or moral objection creates an inadmissibility ground. Waivers exist but require additional processing.

Unmanaged substance use disorders: Active substance abuse or addiction is flagged. Treatment and documentation of management can resolve this with appropriate medical waiver filings.

The medical exam is one of the more straightforward hurdles in the marriage green card process, but going to an unauthorized physician or submitting an improperly handled I-693 wastes months. The US Green Card Through Marriage Guide includes the full checklist of what to bring to your civil surgeon appointment and how the I-693 fits into your complete application packet.