Immigration Medical Exam: What to Expect at Every Step

Most applicants walk into the immigration physical exam blind — not because they failed to research, but because government websites are written for doctors, not patients. They tell you what conditions are screened for. They don't tell you that forgetting to bring old TB records can trigger an eight-week culture delay, or that a missing vaccine you've never heard of can send you back for a second appointment.

This is the complete picture: who performs the exam, what happens in the room, what gets screened, and what the results mean for your application.

Who Can Perform an Immigration Medical Exam

Your personal physician cannot sign off on an immigration medical. The exam must be performed by a government-designated practitioner — and that designation varies by country:

• United States (adjustment of status): A USCIS-designated civil surgeon. You must use this Form I-693 system; no exceptions.
• United States (consular processing abroad): A DOS-authorized panel physician at or near your local U.S. embassy.
• Canada (IRCC): A Designated Medical Practitioner (DMP), often accessed through IOM clinics.
• Australia (DHA): A panel physician registered with the Department of Home Affairs, typically through the Bupa Medical Visa Services network or eMedical-connected clinics.
• United Kingdom: No general medical exam for most visas — only a TB certificate from a Home Office-approved clinic, required for stays over six months from more than 100 high-incidence countries.
• New Zealand: A panel physician submitting results via eMedical (INZ 1007 medical certificate + INZ 1096 chest X-ray certificate).

Results go directly to the immigration authority — either electronically through eMedical or, in the U.S. adjustment of status process, in a sealed envelope you hand to USCIS. You do not receive your own "results" to share with anyone.

When to Book the Exam

Timing matters more than most applicants realize.

Wait for the instruction, not your calendar. Unless your visa category specifically mandates an "upfront" medical (Canada's Express Entry 2026 rules now require the IMM 1017B printout at e-APR submission), booking early creates expiry risk. Most exam results are valid for 12 months. If your application sits in a processing queue longer than that, you pay for the exam twice.

For U.S. adjustment of status, a June 2025 policy update clarified that Form I-693 is now only valid for the specific I-485 it accompanies. If that application is denied or withdrawn, the medical is void for any new filing. Additionally, since December 2024, the sealed I-693 must be submitted concurrently with the I-485 — not held separately or mailed later.

The practical rule: book once you receive the official medical request from the government, not before.

What Happens During the Physical Exam

The immigration physical exam is a head-to-toe clinical assessment divided into three parts.

Physical assessment. The physician reviews your full medical history — past surgeries, hospitalizations, chronic conditions, and current medications — then performs a standard examination: height, weight, blood pressure, heart rate, vision screening, hearing check, and a systemic review of your heart, lungs, abdomen, skin, and musculoskeletal system. You will be asked to undress to your underwear; a gown is provided.

Mental health evaluation. The surgeon assesses orientation, mood, affect, thought process, and behavior. A diagnosis of depression, anxiety, or ADHD is not itself a bar to entry. The legal standard is "harmful behavior" — documented violence, repeated suicidal attempts with hospitalization, or active substance abuse with a pattern of public endangerment. If you have a mental health history, bring a dated letter from your treating psychiatrist confirming current stability and the absence of harmful behavior. This can preempt a costly referral to a government-appointed specialist.

Substance use assessment. U.S. rules are notably strict here: marijuana use — even in jurisdictions where it's legal — can be documented as drug abuse, requiring a 12-month remission period before the I-693 can be cleared.

Lab Tests and Radiology

The tests required depend on your age, your destination country, and your health history.

Chest X-ray. Required for most applicants aged 11 and older. If the X-ray shows any abnormality — scarring, a shadow, granulomas — even one that is old and asymptomatic, the case is referred for sputum testing. Sputum collection takes three consecutive mornings; cultures take 8–9 weeks to process. Evidence from high-volume clinics like St. Luke's in Manila suggests that approximately 93% of sputum referrals come back negative — but the wait is unavoidable once triggered. Bringing your previous X-ray films and any prior TB treatment records to the appointment can help the physician distinguish old scarring from a new concern and potentially avoid the referral.

Pregnant applicants. The chest X-ray can be performed with double lead shielding in the second or third trimester, or deferred until after delivery.

Vaccination Check

For U.S. immigration, the civil surgeon must verify your vaccination history against the CDC's age-based schedule. If you're missing vaccines or can't prove immunity, you'll receive them at the clinic — at clinic prices. Vaccines administered at immigration clinics cost significantly more than pharmacy or public health prices: a single MMR dose can run $180–$250 at a clinic versus $20–$80 elsewhere.

The more efficient approach: pull your vaccination records before the appointment, identify any gaps using the CDC's adult immunization schedule, and get catch-up doses at a pharmacy or through your primary care physician. Bring the official documentation — signed pharmacy records or a pediatrician printout — to the civil surgeon.

You do not need to complete a full multi-dose series before the I-693 is signed. Civil surgeons can sign off once the first dose is administered and document that subsequent doses will follow on the appropriate schedule.

Canada, Australia, and New Zealand do not have the same statutory vaccination mandate structure as the U.S. Their exams focus on disease screening and the "excessive demand" cost assessment rather than verifying vaccination records.

What Conditions Can Cause Inadmissibility

Medical inadmissibility falls into three categories:

Communicable disease. Active tuberculosis, untreated syphilis, and gonorrhea are the primary grounds. Managed or treated infections are typically cleared. The critical distinction is "active" versus "latent" or "treated."

Mental health with harmful behavior. As noted above, a diagnosis alone is insufficient grounds for inadmissibility. The pattern of harmful behavior associated with the condition is what matters.

Excessive demand on health or social services. This is the primary concern for Canada (threshold: CAD $28,878 per year / $144,390 over five years in 2026) and Australia (AUD $86,000 over five years). Conditions such as end-stage renal disease requiring dialysis, certain high-cost malignancies, or severe conditions requiring 24/7 institutional care are the main targets. Managed conditions — controlled hypertension, stable asthma, well-managed type 2 diabetes — are generally not issues.

If a medical officer flags a potential excessive demand concern, you are not refused on the spot. Canada issues a Procedural Fairness Letter (PFL) giving you 60–90 days to respond with specialist documentation, treatment alternatives, or a mitigation plan. A proactive approach — preparing a specialist letter before the exam for any condition that might be flagged — is significantly cheaper than a reactive PFL response drafted by an immigration lawyer.

After the Exam

For U.S. adjustment of status, you leave the appointment with a sealed envelope containing Form I-693. Do not open it. Submit it alongside your I-485.

For Canada, Australia, and New Zealand, the results are transmitted electronically via eMedical directly to the immigration authority. You receive a confirmation that your medical has been submitted but not the clinical findings themselves.

If the physician identifies something that requires follow-up — an abnormal kidney function result, a chest X-ray shadow, or a positive syphilis screen — you'll receive a "furtherance" referral. Additional specialist appointments for furtherance in Canada typically cost CAD $90–$200 extra and can add weeks to your timeline.

Applicants found to have inactive TB or treated syphilis are typically cleared but placed on a "medical surveillance" requirement, meaning they must report to public health authorities in the destination country after arrival.

The Immigration Medical Exam Preparation Guide covers the full appointment checklist, a country-by-country comparison of what each panel physician system actually tests, a vaccination timing planner, and strategies for managing flagged conditions before your appointment.