What this guide is best for
Direct answer: Use this guide when you need one clear comparison or caution explained before you contact anyone.
Best used when: A city or state page is too broad and you need one cleaner decision path.
Quick answer
Three instructions on the current Form I-693 page contradict advice that is still repeated everywhere, including on pages that were correct when they were written.
- You submit Form I-693 with Form I-485. USCIS: “Effective Dec. 2, 2024, you must submit Form I-693, or a partial Form I-693 (such as the Vaccination Record), and you must submit it with your Form I-485. Otherwise, we may reject your Form I-485.” The older practice of filing the medical later, or waiting for USCIS to ask, is gone.
- If you file I-485 online, you open the envelope. USCIS: “If you file Form I-485 online, you must open the sealed envelope from the civil surgeon and upload the completed Form I-693 with your application package.”
- Only one edition of the form is now accepted. If the civil surgeon signs on 3 July 2025 or later, USCIS accepts only the 01/20/25 edition.
Point two is the one that costs people money, because the universal advice is the opposite. It is correct advice — for paper filers.
Sealed or opened: it depends on how you file
| Filing Form I-485 by mail | Filing Form I-485 online | |
|---|---|---|
| The envelope | Stays sealed. Submit it in the original sealed envelope provided by the civil surgeon | You open it yourself and upload the completed form |
| Where it goes | By mail with the I-485, to the address specified for your I-485 | Uploaded with the I-485 application package |
| What you keep | Nothing further — USCIS holds it | The original Form I-693 and the envelope, until USCIS makes a final decision on the I-485 |
| Why you keep it | — | USCIS may review the original during an interview, or ask you to submit it as evidence |
Source: USCIS, Form I-693 page, uscis.gov/i-693.
Read the online column again. Opening the envelope is not the end of the document’s life. You are still holding the original and the envelope until the case is decided, and USCIS can ask for both. An online filer who opens the envelope and then discards it has followed half the instruction.
There is also a third case, which almost nobody plans for. If a lockbox rejects your package and returns it with the I-693 envelope already opened, USCIS says you may include that original opened Form I-693, with the supporting documentation the civil surgeon included, in its original envelope, together with a copy of the rejection notice. An opened envelope is not automatically a wasted exam.
The edition date is a rejection risk
USCIS rejects forms on mechanical grounds before anyone reads them, and the edition date is one of those grounds.
- The current edition of Form I-693 is 01/20/25.
- If the civil surgeon signed on or before 2 July 2025, USCIS accepts the 03/09/23 or the 01/20/25 edition.
- If the civil surgeon signed on 3 July 2025 or later, USCIS accepts only the 01/20/25 edition.
- The edition date is printed at the bottom of the page, on both the form and the instructions.
USCIS adds a printing instruction that reads like housekeeping and is not: if you print the form to mail it, the edition date and page numbers must be visible at the bottom of all pages, and every page must come from the same form edition. Missing pages, or pages from different editions, may be rejected.
Two further mechanical rules from the same page: an unsigned form will be rejected, and you — not the civil surgeon — submit the form to USCIS.
Questions to ask: which edition of the form the clinic is completing, and on what date they will sign it. Both are printed on the sheet in front of them. Common mistake: booking the exam months ahead of filing and discovering the signed edition is no longer the accepted one.
When a partial I-693 is what USCIS wants
Some applicants have already had an immigration medical examination abroad, conducted by a panel physician rather than a civil surgeon. They are not asked to repeat the whole thing. USCIS names a partial Form I-693 — Parts 1 to 5, Part 7, and Part 10, the Vaccination Record.
USCIS lists who this applies to. Read the current form page for the governing text; in outline it covers:
- Refugees, and derivative asylees filing within the stated window, who already completed an examination by a panel physician abroad
- K-1, K-2, K-3 and K-4 nonimmigrants whose examination abroad was recent, where the vaccination record was not properly completed as part of it
- Afghan nationals who arrived under Operation Allies Welcome, in the same circumstance
USCIS also flags the reverse case: where an examination abroad revealed a Class A medical condition, or there is reason to believe one was acquired after admission or parole, a new examination may be needed. The health-related grounds of inadmissibility are at section 212(a)(1) of the Immigration and Nationality Act.
If any of this describes you, the form instructions govern, and this page does not. Read them and take the question to counsel rather than guessing at which parts to complete.
What the form costs, and what the exam costs
These are two different numbers and only one of them exists on paper.
| Item | Set by | Amount |
|---|---|---|
| Filing Form I-693 | USCIS | $0 |
| Filing Form I-485, applicant over 14 | USCIS | Paper $1,440 / online $1,390 |
| Filing Form I-485, under 14 with a parent’s I-485 | USCIS | Paper $950 / online $900 |
| The immigration medical examination itself | The civil surgeon | Not published |
Source: Form G-1055, the USCIS fee schedule, edition 05/29/26. On the exam fee, USCIS states on the I-693 page itself: “Fees for immigration medical examinations are established by the civil surgeon. Fees may vary by civil surgeon.”
That sentence is the whole reason no honest national average for this exam exists. Any figure presented as one is an estimate wearing a source’s clothing.
What to do next
- Decide whether you are filing Form I-485 by mail or online, before the exam, because it changes what you do with the envelope.
- Tell the civil surgeon’s office which one, and confirm the form edition they will use.
- If filing online: open the envelope, upload the form, and keep the original and the envelope until the case is decided.
- If filing by mail: do not open it, and send it with the I-485, not separately.
- Read the current Form I-693 instructions on uscis.gov before you file. This page summarises them; it does not replace them.
Sources used on this page: USCIS, Form I-693 page and its linked Instructions for Form I-693, edition 01/20/25, uscis.gov/i-693; USCIS Policy Manual Volume 8, Part B, Chapter 4 on the validity of Form I-693; Form G-1055, USCIS fee schedule, edition 05/29/26; Immigration and Nationality Act section 212(a)(1).
Educational only. Not legal or medical advice. Filing rules on this form have changed repeatedly since 2023 and can change again; confirm the current instruction on uscis.gov before acting on anything here.