The short answer
- You can book a USCIS-designated civil surgeon now; you do not need to wait for your law firm. An exam by your regular family doctor does not count.
- File Form I-693 together with the I-485 (required since December 2, 2024), or USCIS may reject the I-485. An I-693 signed on or after November 1, 2023 stays valid while the application it was filed with is pending, and the old "within 60 days of the signature" rule is gone.[1][2]
- You pay the civil surgeon directly, and vaccines may cost extra. Never open the sealed envelope the doctor gives you: USCIS returns a form whose envelope was opened.[4]
Since Chart B opened I-485 filing (the application to adjust status, the form you file to get a green card from inside the United States) in October, the question people ask most is about the immigration medical exam: when to go, which clinic, which vaccines, how much it costs, and whether the company pays.
Below, one question at a time. For each point we checked the original text of the USCIS Policy Manual, the Form I-693 (Report of Immigration Medical Examination and Vaccination Record) instructions, and the official guidance the Centers for Disease Control and Prevention (CDC) gives to exam doctors.
01 When should I do the exam? How long does an early exam stay valid?
You can do it now; there is no need to wait for the law firm. Two rules set the timing:
- It must be filed with the I-485. USCIS states on its official Form I-693 page that from December 2, 2024, the medical form must be submitted together with Form I-485, otherwise USCIS "may reject your Form I-485." So if you want to file on Chart B this month, the exam has to be finished before you file.
- Doing it early is fine while that I-485 is pending. Policy Manual Volume 8, Part B, Chapter 4 says an I-693 signed by the civil surgeon on or after November 1, 2023 stays valid for the entire time "the immigration benefit application with which the Form I-693 is submitted" is pending. The old rule that the form had to be filed within 60 days of the doctor's signature was permanently removed by USCIS on March 31, 2023.
One thing to note: since June 11, 2025, the medical form is valid only for the application it was filed with. If you later file a different application (for example, a new I-485 after a denial), you need a new exam.
02 Where do I find an exam doctor?
Use our medical exam doctor directory for the Bay Area, Boston, Seattle, and New York. For other places and current designation, check USCIS Find a Civil Surgeon. The directory helps you find clinics; it does not endorse one. A family member or friend can help call or book online, subject to the clinic's process. The applicant must attend the exam and have their identity checked. Ask the clinic whether it needs the applicant to confirm the booking personally.[3][4]
The immigration medical exam can only be done by a doctor USCIS has designated as a civil surgeon; an exam by your regular family doctor does not count.
How to search: open the USCIS Find a Civil Surgeon page, enter an address, city or ZIP code, and it lists designated doctors nearby. It works nationwide, the same for the Bay Area, Boston, Seattle and New York. You can also call the USCIS Contact Center at 1-800-375-5283.
The I-693 instructions add a reminder: doctors on the list are generally still designated, but if you are unsure, call and ask directly, "Are you currently a civil surgeon?"
Five things worth asking on the phone:
- The total price, and whether it includes the blood tests (tuberculosis, syphilis) and lab fees.
- Whether missing vaccines can be given on the spot, and how much each shot costs.
- How many days the tuberculosis blood test takes, and roughly how long until you get the sealed envelope.
- Whether you should send your vaccine records in advance.
- Whether the doctor or front desk speaks Chinese (if you need it).
A common complaint in chat groups is "the quote looked cheap, then vaccines and blood tests were extra." Asking for the total price is more useful than comparing the visit fee alone.
How far ahead should I book? Can I walk in?
Reader reports, not an official rule: some clinics have waits of about 2–3 weeks, while others accept walk-ins. Availability varies by clinic and location. Contact a USCIS-designated civil surgeon early as you prepare to file I-485. Ask about the first available appointment, walk-ins, required documents, and when the sealed I-693 will be ready.[3][4]
The directory lists Mandarin or Cantonese. Will my exam doctor speak it?
Do not rely on the language label alone. Our civil-surgeon directory combines languages from USCIS listing data at the clinic level; a clinic may have more than one designated doctor. The label does not guarantee that the doctor who examines you speaks Mandarin or Cantonese, or that staff who speak it will be available on your appointment day. When booking, ask which USCIS-designated doctor will conduct the exam, whether you can communicate in your preferred language that day, and what interpreting arrangements the clinic accepts if you cannot.[3]
03 What is checked on exam day, and what should I bring?
Bring:
Bring valid government photo ID, such as an unexpired passport or driver's license. If you do not have a passport, ask the clinic which ID it accepts. Bring dated vaccine records from home, a pharmacy, or your regular doctor. Complete your identifying details on I-693; the civil surgeon checks the name and A-Number on each page.[4]
What do I put in the two number fields? Your A-Number identifies your immigration record and may appear on DHS or USCIS correspondence. If you have no A-Number, write “N/A.” A USCIS Online Account Number (OAN) is different from an A-Number or a random receipt number. If you previously filed online, look in your USCIS account profile. If you filed by mail and got an IOE receipt number, look at the top of your USCIS Account Access Notice. The instructions say that if you have no IOE receipt number, you have no OAN; the field says “if any,” so do not invent one.[4]
What is checked:
- Under CDC guidance, everyone aged 2 and older gets a tuberculosis blood test (IGRA, interferon-gamma release assay, a blood test for TB infection).
- People aged 18 to 44 are tested for syphilis.
- People aged 18 to 24 are tested for gonorrhea.
- Your vaccines are checked, and missing ones are caught up (see the next section).
The last step matters most: the doctor gives you the completed I-693 in a sealed envelope. The I-693 instructions say: do not accept the form unless it is in a sealed envelope; if the envelope is opened or altered in any way, USCIS will return the form. Never open it yourself. If you want to read it, ask the doctor for a separate copy.
Each family member needs their own exam and files their own I-693.
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Is there a drug test? What if I drank alcohol or ate poppy seeds the day before?
Form I-693 does not require routine urine drug testing for every applicant. CDC directs the civil surgeon to assess each person's history, behavior, and physical findings before deciding whether substance testing is indicated. Separate testing rules apply when a diagnosis of certain substance use disorders is deferred or remission is being assessed.[8] Other required blood or urine tests are not automatically “drug tests”: TB screening generally requires an IGRA for applicants age 2 or older; syphilis testing generally applies at ages 18–44; and gonorrhea testing generally applies at ages 18–24. A civil surgeon may test outside those age ranges when infection is suspected.[9][10][11]
Having a drink the day before does not, by itself, mean you will fail a “drug test.” CDC treats alcohol as a substance outside the Controlled Substances Act; the assessment concerns an alcohol use disorder and any associated harmful behavior. Alcohol laboratory tests are not required for every applicant and cannot replace the clinical assessment.[8] CDC's civil surgeon instructions set no blanket rule against drinking the day before or eating poppy seeds. They also do not guarantee that food or alcohol cannot affect any individual's test result. Follow any instructions your clinic gives about bloodwork, fasting, or medicines, and ask the civil surgeon about your own circumstances.[8][9][10][11]
My vaccine record is only in Chinese. Do I need an English translation?
Bring the original written vaccination record with the vaccine names and dates of each dose. CDC says that although some civil surgeon offices can translate records, the applicant is responsible for providing reliable English translations of records in other languages. A verbal account of past shots does not replace written documentation.[5] Ask the clinic before your visit whether it can use your record, whether it translates records, and what format it needs. Preparing a reliable English translation in advance is the safer choice; the civil surgeon will review the record.[5]
04 Which vaccines do I need? Do I need a flu shot now?
CDC's civil surgeon list covers 15 diseases: diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, rotavirus, Hib, hepatitis A, hepatitis B, meningococcal disease, varicella, pneumococcal disease, and influenza. That does not mean every adult needs 15 shots. The surgeon checks your age, records, and CDC's age table. Do I need a flu shot now? Yes. CDC's age table says the flu vaccine is required for applicants older than six months, given annually. CDC's guidance says the vaccine is usually given from fall through early spring and is often unavailable in summer; when it is unavailable because it is not flu season, the surgeon records “Not flu season.” October is inside the supply period, so if you have no flu-shot record, you generally need to get one at or before the exam.[5][6]
You may get missing shots at a pharmacy or with your regular doctor before the exam. Keep a record showing each vaccine and date. CDC directs the civil surgeon to review valid records and enter prior and newly administered doses on I-693. Simply saying you had a shot generally does not replace documentation. CDC permits immunity blood tests for some vaccines, including varicella; the civil surgeon decides whether the evidence qualifies.[5]
Must I wait a month and receive a second chickenpox shot before the surgeon can sign? Not necessarily. If you lack acceptable disease history, immunity evidence, or vaccine records, the surgeon assesses what is due. Under CDC's general rule, someone who has not finished a multi-dose series receives the dose due at the exam. If the next dose cannot yet be given because the minimum interval has not passed, the surgeon can mark “insufficient time interval to complete series” on I-693. There is no universal one-month wait to sign the form. Finish later doses on the usual vaccine schedule.[5]
A COVID-19 shot is not currently required for the I-485 medical exam. USCIS stopped requiring COVID-19 vaccination documentation on January 22, 2025. COVID-19 is also absent from CDC's March 11, 2025 civil surgeon list.[5][7]
05 Who pays for the exam? Can I get vaccines at a pharmacy?
The I-693 instructions say applicants pay the civil surgeon directly for the exam and required follow-up tests or treatment. Whether an employer reimburses you or your spouse depends on company policy, not a universal USCIS rule. Ask your HR or immigration team and insurer what they cover and which receipts they need.[4]
Pharmacy shots may be covered by insurance, but check the specific vaccine, network, and out-of-pocket cost with the pharmacy and insurer. Some clinics accept cash only. Before booking, ask about payment methods, an itemized receipt, and whether the quote includes blood tests, vaccines, follow-up visits, and the sealed I-693.[4]
Budget example only: Two recent readers in the Bay Area reported base exam prices of about $250 and $300, with possible extra vaccine charges. These are individual reports, not official prices or a reliable national range. Get a written total quote from your clinic. We do not yet have enough reported prices to publish a dependable national range.
06 The three most common mistakes
- Opening the envelope. Once opened it is void, and you have to go back to the doctor to have it resealed.
- Waiting for the law firm before booking. Some readers report 2–3 week waits in busy areas, while some clinics accept walk-ins; the tuberculosis blood test also needs time for results. If you want to file this month, call now.
- Comparing only the visit fee. Ask whether vaccines, blood tests and lab work are charged separately.
Help the next person
Have you filed your I-485, had your biometrics taken, or received your work permit? You can add your dates anonymously to our I-485 progress tracker (filing, biometrics, work permit and similar dates), so the next person can see how long others actually waited.
For everything you need to prepare for the I-485, check the Employment-Based I-485 Document Checklist.
Sources, checked October 2, 2026: [1] USCIS Form I-693 page, concurrent filing from Dec. 2, 2024; [2] USCIS Policy Manual, Vol. 8, Part B, Ch. 4, validity and removal of the 60-day rule on Mar. 31, 2023; [3] USCIS Find a Civil Surgeon; [4] Form I-693 Instructions, Jan. 20, 2025 edition; [5] CDC Vaccination Technical Instructions for Civil Surgeons, Mar. 11, 2025; [6] CDC age table, effective Mar. 11, 2025; [7] USCIS COVID-19 vaccination alert, Jan. 22, 2025; [8] CDC Mental Health Technical Instructions for Civil Surgeons, Aug. 4, 2025; [9] CDC Tuberculosis Technical Instructions for Civil Surgeons, effective Mar. 11, 2024; [10] CDC Syphilis Technical Instructions for Civil Surgeons, Jan. 30, 2025; [11] CDC Gonorrhea Technical Instructions for Civil Surgeons, May 15, 2024. General information only; ask a civil surgeon, insurer, or lawyer about your situation.
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