Every person applying for a green card inside the United States must pass a medical exam before USCIS approves the application. The exam cannot be done by your regular doctor. It must be done by a physician USCIS has specifically designated — called a civil surgeon — using a form called the I-693.
Here is what the exam covers, what it typically costs, and when to submit the form with your application.
What Form I-693 Is
Form I-693 is the Report of Immigration Medical Examination and Vaccination Record. The civil surgeon completes it based on the results of your exam. You do not fill it out yourself. The civil surgeon seals it in an envelope, and you submit that sealed envelope to USCIS — either with your I-485 or at your adjustment of status interview.
USCIS uses this form to check that you do not have a medical condition that would make you inadmissible under immigration law. Most applicants pass without any issue.
Finding a Civil Surgeon in Houston
You cannot go to any licensed physician. The civil surgeon must appear on USCIS’s official list. USCIS maintains a searchable locator at uscis.gov where you can find designated civil surgeons by ZIP code.
Houston has multiple civil surgeons available. Not all of them accept walk-ins, and wait times vary. Call ahead to confirm availability and get a cost estimate before you book.
What the Exam Covers
The civil surgeon reviews four areas: vaccinations, physical health, mental health, and substance abuse history.
Vaccinations are often the most time-consuming part. USCIS requires proof of all vaccines on the CDC’s schedule for immigrants, including mumps, measles, rubella, polio, tetanus, hepatitis A and B, influenza, and others depending on your age and prior vaccination history. If you are missing vaccines, the civil surgeon administers them during the exam or requires you to return after completing a vaccine series.
Bring every vaccination record you have. If you were vaccinated outside the United States, bring those records too. Missing documentation means more shots.
Physical exam covers general health: blood pressure, vision, hearing, chest, abdomen, and skin. You will also need a tuberculosis test (either a skin test or blood test). A chest X-ray is required for applicants 15 and older if the TB screening result is positive or indeterminate.
Mental health and substance abuse are evaluated through a medical history questionnaire and interview with the civil surgeon. Current substance abuse disorders are a ground of inadmissibility. Past history does not automatically disqualify you.
What the Exam Costs
Civil surgeons set their own fees. In the Houston area, expect to pay between $200 and $500 for the exam itself. Vaccines are charged separately at the civil surgeon’s rate. If you need several vaccines, total costs can reach $800 or more. USCIS does not reimburse these costs.
Call ahead and ask for an itemized estimate. Some civil surgeons offer a flat package price that includes common vaccines.
How Long Form I-693 Stays Valid
USCIS has changed the validity rules for Form I-693 more than once. Check the current guidance at uscis.gov/i-693 and ask your civil surgeon when your results expire. If USCIS does not adjudicate your I-485 before the form expires, you will need a new exam. This matters if your application is pending for an extended period, which happens in some employment-based cases with long priority date backlogs.
When to Submit It
You have two options. You can submit Form I-693 in the sealed envelope together with your I-485 at the time of filing. Or you can wait and bring it to your adjustment of status interview.
Submitting with the I-485 is generally faster. USCIS can review the medical results before the interview, which reduces the chance the interview gets delayed because of a missing document. If you are not yet ready to schedule the exam when you file — for example, if you are waiting on vaccine records from abroad — you can bring it to the interview instead.
Do not open the sealed envelope. If the seal is broken when USCIS receives it, they will reject the form and require a new exam.
If the Civil Surgeon Flags a Condition
Medical conditions that can affect a green card application fall into two categories: Class A and Class B.
Class A conditions are grounds of inadmissibility. They include active tuberculosis, untreated syphilis, current substance abuse disorders, and certain mental health conditions with a history of harmful behavior. A Class A finding does not automatically end your case — some conditions are treatable, and waivers exist for others — but it does require additional steps.
Class B conditions are conditions that are present but do not make you inadmissible. They are noted on the form but do not block approval.
If the civil surgeon identifies anything that could be a Class A condition, talk to your immigration attorney before taking any further steps. The sequence of how you respond matters.
One Thing Many Applicants Miss
The civil surgeon cannot release Form I-693 to you if you have outstanding vaccine requirements. Some vaccines require two or three doses spaced weeks apart — the hepatitis B series, for example, takes six months to complete. If you start the process late, it can delay your entire I-485 submission. Schedule the exam early, and bring every vaccination record you have to the first appointment.
Adan G. Vega & Associates handles adjustment of status cases for applicants throughout Houston. Our attorneys are Board-Certified and bilingual in English and Spanish. Call (713) 527-9606 to schedule a consultation, or see our Houston green card lawyer page for more on the I-485 process.
Reviewed by Adan Vega, Board-Certified Immigration Attorney, Founding Partner · Updated
About the author
Board-Certified Immigration Attorney, Founding Partner · Texas Board-Certified Specialist in Immigration and Nationality Law — Texas Board of Legal Specialization (1985); Admitted, U.S. Supreme Court (2004); Admitted, U.S. Court of Appeals for the Fifth Circuit (1980); J.D., The University of Texas at Austin School of Law (1979); B.A., Rice University (1976); Member, American Immigration Lawyers Association (AILA) (1982); Texas Super Lawyers — Thomson Reuters (2004); Special Service Award — Migration and Refugee Services, United States Catholic Conference
Adan G. Vega is a Board-Certified Immigration Attorney and the founding partner of Vega & Associates, PLLC in Houston, Texas. He has practiced immigration and nationality law exclusively for more than 45 years, making him one of the longest-serving immigration attorneys in Houston. He earned a B.A. from Rice University in 1976 and a J.D. from the University of Texas at Austin School of Law in 1979. In 1985 the Texas Board of Legal Specialization awarded him a Certificate of Special Competence in Immigration and Nationality Law, authorizing the title Board Certified Specialist. He is admitted to practice before the Texas state courts, the EOIR Immigration Courts, the U.S. District Court for the Southern District of Texas, the U.S. Court of Appeals for the Fifth Circuit and the U.S. Supreme Court, and has presented oral argument in the Fifth Circuit on three occasions, including one published opinion.
On August 23, 1988, Vega testified before the U.S. House of Representatives Committee on the Judiciary, Subcommittee on Immigration, Refugees and International Law, on the effects of the Immigration Reform and Control Act of 1986. He has served as immigration legal counsel to foreign governments in the United States, including the governments of Mexico and El Salvador, and to multinational companies on employment-based immigration.
A member of the American Immigration Lawyers Association since 1982, he co-chaired the AILA Texas Chapter Conference in 1997, 1998, 1999 and 2004, and has lectured on immigration law at AILA conferences and at the University of Texas. He authored the Guide of United States History and Government in 1989. The Migration and Refugee Services of the United States Catholic Conference presented him with a special service award for outstanding commitment and dedicated service to newcomers.
Vega was a founder and initial director of the Houston Hispanic Chamber of Commerce in 1984, served as President of Consejo Hispano from 1987 to 1988, and has served as special immigration legal counsel, board director, vice president and president of the Cámara de Empresarios Latinos de Houston. He has provided pro bono immigration services to Texas's indigent community throughout his career. He has been recognized as a Top Texas Lawyer by Super Lawyers (Thomson Reuters) since 2004. He represents individuals, families and businesses before USCIS, the Immigration Courts, the Board of Immigration Appeals and the Fifth Circuit Court of Appeals, and is bilingual in English and Spanish.
