USCIS Forms · Updated 2026
Form I-693: Report of Immigration Medical Examination and Vaccination Record
The immigration medical exam in a marriage green card case. Who completes it, why it travels in a sealed envelope, when you file it, and how long it stays valid under current USCIS policy.
Summary
Form I-693 is the immigration medical exam. The immigrant spouse (the applicant) gets the exam from a USCIS-designated civil surgeon (a doctor USCIS has authorized for immigration exams), not a regular family doctor. The civil surgeon completes the form, seals it in an envelope, and signs across the flap. You submit it in that original sealed envelope, unopened, with your I-485 (the green card application, also called Adjustment of Status, or AOS) in most cases. There is no USCIS filing fee; you pay the civil surgeon's exam fee directly. An I-693 signed on or after November 1, 2023 stays valid as long as the I-485 it was filed with is pending.
At a glance
| What it is | The immigration medical exam, Report of Immigration Medical Examination and Vaccination Record |
| Who completes it | A USCIS-designated civil surgeon (a doctor USCIS has authorized for immigration exams), not a regular family doctor. The immigrant spouse (the applicant) gets the exam; the petitioner does not. |
| Form edition | Edition 01/20/25. Download a fresh copy from uscis.gov on the day you compile the packet. |
| USCIS filing fee | $0. There is no USCIS fee for I-693. The applicant pays the civil surgeon's exam fee directly. |
| How it is submitted | In the original SEALED envelope the civil surgeon signs across the flap. USCIS rejects an envelope that has been opened. |
| When to file | With the I-485 in most cases. The I-485 instructions direct applicants to include the sealed I-693 with the packet whenever possible. |
Form edition and policy are current as of May 2026. Always verify the current edition at uscis.gov/i-693 before filing.
What Form I-693 is, in plain English
Form I-693 is the immigration medical exam. Its full name is the Report of Immigration Medical Examination and Vaccination Record. Its job is to show USCIS that the immigrant spouse does not have a health condition that would make them inadmissible, and that their vaccinations are up to date.
The exam is not done by just any doctor. It must be performed by a civil surgeon: a physician USCIS has specifically designated to carry out immigration medical exams inside the United States. A regular family doctor cannot complete the form unless they are on the USCIS civil surgeon list.
In a marriage green card case, the applicant (the immigrant spouse, the person seeking the green card) is the one who gets the exam. The petitioner (the U.S. citizen or green card holder doing the sponsoring, sometimes called the beneficiary's sponsor) does not need a medical exam. The beneficiary here is the immigrant spouse who benefits from the petition.
The civil surgeon and the sealed envelope
The process runs through a USCIS-designated civil surgeon from start to finish. The applicant never fills out the medical sections; the civil surgeon does. The most important rule is the sealed envelope: once the civil surgeon seals the form, it stays sealed.
- 1The applicant books an appointment with a USCIS-designated civil surgeon (find one through the USCIS Find a Doctor tool at uscis.gov).
- 2The civil surgeon performs the physical exam, reviews vaccination records, and orders any required tests.
- 3The civil surgeon completes and signs Form I-693, then seals it inside an envelope and signs across the flap.
- 4The applicant submits the I-693 in that original sealed envelope, unopened, as part of the I-485 packet.
Never open the envelope
USCIS rejects an I-693 that arrives in an envelope that has been opened. The civil surgeon signs across the sealed flap so USCIS can confirm it was never tampered with. If you want a record for yourself, ask the civil surgeon for a separate copy at the appointment; do not open the sealed envelope to make one.
For a field-level walkthrough of the civil surgeon process and the sealed envelope rule, see Civil surgeon and the sealed envelope rule.
When to file it, and how long it stays valid
USCIS expects the sealed I-693 filed with the I-485 in most cases. The I-485 instructions are the authority here: they direct applicants to include the sealed I-693 with the application packet whenever possible. If the exam is not ready in time, USCIS may request it later.
Validity has changed. Here is the current picture:
- 1An I-693 signed by the civil surgeon on or after November 1, 2023 is valid as long as the I-485 it was filed with stays pending.
- 2Under the USCIS policy update effective June 11, 2025, the exam is tied to that specific application. If that I-485 is withdrawn or denied, the I-693 is no longer valid.
- 3The older two-year validity framing no longer reflects current USCIS policy. Do not rely on a flat expiration date.
The old two-year rule no longer applies
Many older articles still say the I-693 is valid for two years from the date of signature. That framing does not match current USCIS policy. The exam is now tied to the specific I-485 it was filed with, so its validity depends on that application staying pending, not on a flat two-year clock.
For the full timing and validity breakdown, see When to submit: medical exam timing and validity.
Questions on this form
The two questions applicants ask most about Form I-693, each broken down step by step.
What it costs
There is no USCIS filing fee for Form I-693. USCIS does not charge to process the medical exam itself.
What you do pay is the civil surgeon's exam fee, and you pay it directly to the civil surgeon's office. Each civil surgeon sets their own fee, and it can vary by location and by which tests and vaccines you need. Ask for the total cost when you book so there are no surprises. Required vaccines that the civil surgeon administers at the visit may add to the bill.
Common mistakes and how to avoid them
Most I-693 problems come from a small set of avoidable errors around the civil surgeon, the sealed envelope, and timing.
- 01
Going to a regular doctor instead of a civil surgeon
Inside the United States, only a USCIS-designated civil surgeon can complete Form I-693. A regular family doctor cannot, unless they appear on the USCIS civil surgeon list. Confirm the doctor is an authorized civil surgeon before booking, using the USCIS Find a Doctor tool.
- 02
Opening the sealed envelope
USCIS rejects an I-693 that arrives in an envelope that has been opened. Once the civil surgeon seals and signs the flap, leave it sealed. If you want a record for yourself, ask the civil surgeon for a copy at the appointment.
- 03
Assuming a flat two-year expiration
Current policy ties the I-693 to the specific I-485 it was filed with, not to a fixed two-year window. Relying on outdated two-year advice can lead applicants to redo an exam they did not need, or to misjudge when one is still valid.
- 04
Filing the exam separately from the I-485 without checking
USCIS expects the sealed I-693 filed with the I-485 in most cases. The I-485 instructions are the authority here. Check the current instructions before deciding to send the exam on its own.
- 05
Skipping required vaccinations
The civil surgeon records vaccination history and can administer missing vaccines at the visit. Bring all vaccination records to the appointment so the civil surgeon can complete the vaccination section without a follow-up trip.
A note on medical findings
This page explains the I-693 process: who completes it, how it is filed, and when it is valid. It does not interpret medical findings or vaccination requirements, and it is not medical advice. Your civil surgeon answers questions about the exam, test results, and which vaccines you need.
If a medical condition raises an inadmissibility question, or if you may need a waiver, that is a legal matter. Talk to a licensed immigration attorney before filing.
Frequently asked questions
Who completes Form I-693?
The immigrant spouse (the applicant, the person seeking the green card) gets the medical exam from a USCIS-designated civil surgeon. A civil surgeon is a doctor USCIS has authorized to perform immigration medical exams. The petitioner (the sponsoring spouse) does not need an exam. The civil surgeon completes and signs the form, then seals it in an envelope.
When do I submit Form I-693?
USCIS expects Form I-693 to be filed with the I-485 (the Application to Register Permanent Residence or Adjust Status) in most cases. The current I-485 instructions direct applicants to include the sealed I-693 with the application packet whenever possible. If it is not ready in time, USCIS may request the exam later.
How long is Form I-693 valid?
An I-693 signed by the civil surgeon on or after November 1, 2023 is valid as long as the I-485 it was filed with stays pending. Under the USCIS policy update effective June 11, 2025, the exam is tied to that specific application. If that I-485 is withdrawn or denied, the I-693 is no longer valid. The older two-year validity framing no longer reflects current policy.
Is there a USCIS filing fee for Form I-693?
No. There is no USCIS filing fee for Form I-693. The applicant pays the civil surgeon's exam fee directly. That fee is set by each civil surgeon and is separate from any USCIS form fees.
Why must Form I-693 stay in a sealed envelope?
The civil surgeon seals the completed I-693 in an envelope and signs across the flap. USCIS rejects an I-693 that arrives in an envelope that has been opened, so the applicant submits it in the original sealed envelope and never opens it. Keep a copy if the civil surgeon provides one.
Can a regular doctor complete Form I-693?
No. Inside the United States, only a USCIS-designated civil surgeon can complete Form I-693. A regular family doctor cannot, unless they are on the USCIS civil surgeon list. Applicants find an authorized civil surgeon through the USCIS Find a Doctor tool at uscis.gov.
Key takeaways
- ✓
Form I-693 is the immigration medical exam. It must be completed by a USCIS-designated civil surgeon, a doctor USCIS has authorized for immigration exams, not a regular family doctor.
- ✓
The immigrant spouse (the applicant) gets the exam. The petitioner (the sponsoring spouse) does not.
- ✓
The civil surgeon seals the signed form in an envelope. Submit it in that original sealed envelope and never open it; USCIS rejects an envelope that has been opened.
- ✓
USCIS expects the sealed I-693 filed with the I-485 in most cases. The I-485 instructions are the authority on timing.
- ✓
An I-693 signed on or after November 1, 2023 stays valid as long as the I-485 it was filed with is pending. Under the policy update effective June 11, 2025, it is tied to that specific application: if that I-485 is withdrawn or denied, the exam is no longer valid.
- ✓
There is no USCIS filing fee for I-693. The applicant pays the civil surgeon's exam fee directly.
- ✓
The current edition is 01/20/25. Download a fresh copy from uscis.gov on the day you compile your packet.
How Green Card Genius fits
Green Card Genius is self-help immigration software built for marriage-based green card cases. The software walks you through plain-English questions and assembles your full I-485 packet for you to review and sign. The medical exam itself must be done in person with a USCIS-designated civil surgeon, which is not something software can do for you, but Green Card Genius points you to the USCIS civil surgeon locator and makes sure the rest of your packet is ready to file alongside the sealed envelope. The one-time fee is $99, and the Denial Protection Guarantee returns the $99 service fee if USCIS denies the application. Government filing fees go directly to USCIS and are separate.
Green Card Genius is not a law firm and does not provide legal advice.
Start your marriage green card for $99This guide is for educational purposes only and is not legal or medical advice. Green Card Genius is self-help immigration software, not a law firm, and does not provide legal representation. Immigration law and USCIS policy change frequently. For advice on a specific case, consult a licensed immigration attorney; for medical questions, ask your civil surgeon. Information is current as of May 2026; verify the form edition, fees, and filing rules at uscis.gov before filing.
Keep reading on the medical exam
A deeper walkthrough of the I-693 medical exam, plus how it fits into the I-485 green card application.
Continue reading
- 01When to Submit Form I-693: Medical Exam Timing & Validity (2026)
- 02I-693 Civil Surgeon and Sealed Envelope Rule (2026)
- 03Green Card Medical Exam (Form I-693): What You Need to Know (2026)
- 04Form I-485: Application to Adjust Status (2026 Guide)
- 05Marriage Green Card by Country: Country-Specific Guides (2026)
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