How to Choose a Civil Surgeon

Your Civil Surgeon is the only person USCIS authorizes to complete Form I-693, the medical examination required for most Adjustment of Status cases. The quality of that exam, and how cleanly the envelope arrives sealed at USCIS, can determine whether you get a Request for Evidence (RFE) eight months into your timeline. Picking the right provider is not optional. Below is the framework we use internally to vet every clinic in our network, distilled into something you can apply yourself.

Red flags to walk away from

If you encounter any of the following while shopping for a Civil Surgeon, keep looking:

• Quoted price above $400 for the exam alone. The fair-market price for a standard I-693 visit (history, physical, vaccine record review, TB screening referral) sits at $250–$325. The network standard is a flat $295. Anything over $400 is either bundling unnecessary services or marking up a captive customer.
• "Hidden" or surprise fees not disclosed up front. Re-seal fees, "administrative" fees, fees to release your own records, fees to mail you the sealed envelope. A reputable Civil Surgeon quotes one flat price that includes the form completion, the sealed envelope, and your personal copy.
• No in-house IGRA (blood draw) for TB screening. Since October 1, 2018, USCIS has required Interferon Gamma Release Assay (IGRA) testing for applicants aged 2 and older. If the clinic still uses the Mantoux skin test (TST) for adults or refers you to a separate lab for the blood draw, expect delays of 5–10 days and an extra $80–$150 in lab fees.
• Multi-visit envelope pickup. The exam, vaccine review, and TB result can all be packaged into a single sealed envelope inside 5 business days. Clinics that demand 3+ visits for routine cases are either understaffed or padding the bill.
• "We'll fill it out and you mail it" language. The envelope must be sealed by the Civil Surgeon. If they hand you an unsealed form, USCIS will reject it. This is non-negotiable.

What good service looks like

The clinics we accept into the network meet a published service standard:

Questions to ask before you book

1. Are you currently designated by USCIS as a Civil Surgeon? (Always verify with USCIS’s online tool.)
2. What is the total flat fee, and what does it include?
3. Do you draw IGRA in-house, and what is your typical turnaround?
4. How many visits will I need for a routine case?
5. Do you bill vaccines at cost or at retail rates?
6. Can I get a personal copy of my completed I-693 before the envelope is sealed?
7. Will you accept my foreign vaccination records, and can you read them in their original language?
8. What is your protocol if my TB test comes back positive?

Verify USCIS designation yourself

Every legitimate Civil Surgeon is listed in USCIS’s online "Find a Doctor" directory at uscis.gov/tools/find-a-civil-surgeon. Search by ZIP code and confirm the clinic’s name and address match exactly. If a provider claims designation but does not appear in the directory, walk away. USCIS will not accept an I-693 from a non-designated physician, no matter how clean the form looks.

What to bring to your appointment

• Government-issued photo ID (passport preferred)
• All vaccination records, foreign and domestic, including yellow WHO cards if you have them
• A list of current medications and dosages
• Documentation of any prior TB diagnosis, treatment, or BCG vaccination
• Glasses or contact lenses (vision check is part of the exam)
• Method of payment (most clinics take card; confirm in advance)

Under USCIS policy PA-2023-26, a properly completed I-693 signed on or after November 1, 2023 has indefinite validity, so getting it right the first time is more valuable than ever. There is no longer a 2-year clock to race; there is only the question of whether your form is accepted.

If you want to skip the vetting work, we have already done it. Use our Civil Surgeon directory to find a network clinic near you, read the full I-693 complete guide, or learn what’s included in our standard I-693 exam service.