An immigration physical exam can feel daunting—especially when you are unsure what the appointment involves or which forms you need. In the United States, the immigration medical examination is generally completed by a physician authorized by U.S. Citizenship and Immigration Services (USCIS), known as a civil surgeon. The results are recorded on the government’s medical examination form, not on an unofficial template.
This guide explains what a sample immigration physical exam form may contain, how the examination works, and how to prepare. It is for general information only; it is not a substitute for the current USCIS form, official instructions, or medical advice.
What is an immigration physical exam?
For many people applying to adjust status to lawful permanent resident in the United States, USCIS requires a medical examination to assess health-related grounds of inadmissibility under immigration law. The exam also documents required vaccinations and certain medical findings.
The examination is conducted by a USCIS-designated civil surgeon. Applicants applying for an immigrant visa from outside the United States generally follow a different process through a panel physician authorized by the U.S. Department of State. The correct process depends on the type of application and where it is being filed.
USCIS’s primary form for the adjustment-of-status medical examination is Form I-693, Report of Immigration Medical Examination and Vaccination Record. Always check the USCIS website for the current form edition and filing instructions before an appointment or submission.
A sample immigration physical exam form template
The outline below is a general educational example of the kinds of information that may appear in an immigration medical examination record. It is not an official USCIS form and should not be submitted in place of Form I-693.
Applicant information
- Full legal name
- Date of birth
- Place of birth
- A-number, if applicable
- Current address and contact details
- Identification documents reviewed
Medical history
The civil surgeon may ask about relevant medical history, including:
- Past or current illnesses and diagnoses
- Medications and allergies
- Prior treatment or hospitalization
- History of certain communicable diseases
- Mental or physical conditions relevant to the examination
- Alcohol or drug use, where relevant to the required assessment
The questions and documentation should follow the current USCIS form and instructions. Applicants should answer honestly and ask the clinic how to provide any relevant medical records.
Physical examination
The clinician records findings from the examination. Depending on the applicable requirements and the applicant’s circumstances, this may include general observations and a review of particular body systems.
A sample, non-official section might look like this:
| Examination area | Example entry |
|---|---|
| General appearance | Documented by examining clinician |
| Relevant medical findings | Recorded as required by the official form |
| Additional evaluation needed | Yes / No; details if applicable |
| Clinician’s notes | Relevant findings and follow-up |
This table is illustrative only. It is not a substitute for the official form or the clinician’s judgment.
Tests and screenings
The required tests depend on current public health rules, age, medical history, and the instructions in force at the time of the exam. The civil surgeon will determine which tests are required and arrange them as necessary.
Do not rely on an old online checklist for test requirements. Requirements can change, and an individual’s circumstances may affect what is needed.
Vaccination record
The form includes vaccination information. The civil surgeon reviews available records and determines whether the applicant has documentation of required vaccinations or needs additional vaccination, testing, or a medical exemption documented under the applicable rules.
Bring any reliable vaccination records you have. If records are incomplete or unavailable, ask the clinic what options are appropriate.
Civil surgeon certification
The authorized physician completes the relevant medical findings and certification sections. The applicant may need to review or sign portions of the form, but should not complete clinician-only sections.
The completed form is generally handled according to USCIS instructions, including specific requirements about the sealed envelope or submission method. Follow the instructions that apply to your case and confirm handling with the civil surgeon’s office.
Who needs the examination?
Many applicants filing Form I-485 to adjust status must submit Form I-693, but requirements and timing can vary. Some applicants may qualify for exceptions or may have different instructions based on the basis of their application.
Before booking, review the current USCIS instructions for Form I-485 and Form I-693. If you are applying through a U.S. embassy or consulate abroad, consult the Department of State’s instructions for the relevant immigrant visa process rather than assuming the domestic civil-surgeon procedure applies.
How to prepare for the appointment
A little preparation can help avoid delays and repeat visits.
1. Find an authorized civil surgeon
Use USCIS’s civil surgeon information and follow its current process for locating an authorized provider. A regular family doctor may not be authorized to perform the immigration examination unless they have the required designation.
2. Confirm the current form and instructions
Check USCIS.gov shortly before your appointment. Confirm the latest Form I-693 edition, any changes to filing procedures, and what the clinic expects you to bring.
3. Bring identification and medical records
Ask the clinic what documents it requires. Commonly requested items may include:
- Government-issued photo identification
- Vaccination records
- Relevant medical records or specialist reports
- A list of medications and allergies
- Prior immigration medical paperwork, if relevant
Requirements vary by clinic and case, so confirm in advance.
4. Ask about cost and follow-up
Fees are set by individual civil surgeons, and charges for laboratory work or vaccinations may be separate. Ask for an estimate, whether insurance is accepted, and how the office handles additional tests or follow-up appointments.
5. Don’t complete the official form on your own
The civil surgeon is responsible for the medical examination and the clinician sections of Form I-693. You can provide accurate personal information and records, but do not alter or fill out medical findings yourself.
Common mistakes to avoid
- Using an unofficial template as the required form. A sample form is for understanding the process only. Use the current USCIS form and instructions.
- Going to a doctor who is not an authorized civil surgeon. Confirm the provider’s designation before booking.
- Forgetting vaccination documentation. Missing records may mean extra steps or a return visit.
- Assuming every applicant has identical requirements. The clinician and official instructions determine what applies to your situation.
- Opening or mishandling a sealed envelope. Follow the civil surgeon’s and USCIS’s current instructions for delivery and submission.
- Relying on outdated online advice. Forms, medical guidance, and filing procedures can change.
Frequently asked questions
Is there a downloadable sample Form I-693?
USCIS publishes the official Form I-693 and its instructions. For the latest version, use the form page on the USCIS website. Unofficial samples may be outdated or incomplete and should not be filed.
Can my regular doctor complete the form?
Only a physician authorized by USCIS as a civil surgeon may complete the U.S. adjustment-of-status medical examination. Confirm authorization before scheduling.
Does the medical exam guarantee approval of my immigration application?
No. The medical examination is one part of the immigration process. It does not guarantee approval, and USCIS makes the decision on the overall application.
What if the civil surgeon finds something that needs follow-up?
Ask the civil surgeon to explain the next steps and what documentation is required. The outcome depends on the medical finding and the applicable immigration and public health rules. For questions about how a finding affects your case, consider consulting a qualified immigration attorney.
Conclusion
A sample immigration physical exam form can help you understand the general categories of information collected, but it is not an official filing document. For applicants in the United States who need an adjustment-of-status medical examination, the key document is the current USCIS Form I-693, completed by an authorized civil surgeon. Check the latest USCIS instructions, bring your records, and confirm the clinic’s requirements before your visit. For case-specific legal questions, seek guidance from a qualified immigration attorney.
Sources
- U.S. Citizenship and Immigration Services, Form I-693, Report of Immigration Medical Examination and Vaccination Record: https://www.uscis.gov/i-693
- U.S. Citizenship and Immigration Services, Find a Civil Surgeon: https://www.uscis.gov/tools/find-a-civil-surgeon
- U.S. Citizenship and Immigration Services, Form I-485, Application to Register Permanent Residence or Adjust Status: https://www.uscis.gov/i-485
- U.S. Department of State, U.S. Visas—Medical Examination: https://travel.state.gov/content/travel/en/us-visas/immigrate/the-immigrant-visa-process/interview/medical-examination.html
Immigration forms and procedures can change. Verify current requirements directly with USCIS or the Department of State before acting.