Immigration Medical Exam in Las Vegas: What to Bring, What Happens, and What It Costs

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Posted: Aug 18th, 2026 at 12:00AM - by Ashlee Arnold/Vice President

If you are applying for a green card through adjustment of status, you will need a medical exam completed by a USCIS-designated civil surgeon. The results go on Form I-693, and that form gets filed with your Form I-485.

It is a straightforward appointment. What makes it stressful is that a small mistake — a missing vaccine record, an envelope that got opened, the wrong doctor — can mean redoing the whole thing and paying for it twice. This guide covers what actually happens at the visit and how to get it right the first time.

Your Regular Doctor Cannot Do This Exam

This is the mistake that costs applicants the most money, and it happens regularly.

Only a physician that USCIS has specifically designated as a civil surgeon may perform the immigration medical exam and sign Form I-693. It does not matter how well qualified your regular doctor is, how long you have been seeing them, or whether they are board certified in exactly the right specialty. If they are not a designated civil surgeon, USCIS will not accept the form, and you will need to start over with someone who is.

e7 Health has a designated civil surgeon on staff in Las Vegas. You can also verify any provider's designation using the civil surgeon locator on the USCIS website before you book.

What to Bring to Your Appointment

Bring these four things. The second one is the difference between one visit and two.

• Photo identification. A valid passport, permanent resident card, driver's license, or other government-issued identification.
• Your vaccination records. Every record you can find — childhood shot records, records from your home country, records from a previous employer or school, anything in your patient portal from a prior U.S. provider. Records in another language are still useful; bring them.
• Relevant medical history. If you have been treated for tuberculosis, a chronic condition, or a mental health condition, bring documentation and a list of current medications.
• Form I-693, current edition. Some applicants bring a partially completed copy; your civil surgeon's office may prefer to print the current edition themselves. Confirm when you book.

Arriving without vaccination records is the single most expensive avoidable mistake in this process. Without documentation, the civil surgeon cannot credit vaccines you have already received — which means either paying for shots you did not need, or paying for titer blood tests to prove existing immunity. Either way, it costs more and can add a visit.

What Happens During the Exam

The appointment follows a protocol set by the CDC, not a general physical. Expect four components.

A medical history review and physical examination.

The civil surgeon reviews your history and performs a physical exam, including screening questions about mental health and substance use. These questions are part of the required protocol and are asked of everyone.

Tuberculosis screening.

Applicants age two and older require an IGRA blood test — an interferon gamma release assay. The older TB skin test is no longer accepted as the initial screen for this age group. If your provider defaults to a skin test, ask about IGRA, because the wrong test will generate a request for evidence from USCIS. A positive IGRA result requires a follow-up chest X-ray. Importantly, a positive result with a clear X-ray and no symptoms indicates latent infection, not active tuberculosis, and is not automatically a bar to a green card.

Blood and urine testing.

Syphilis screening is required for applicants in the relevant age range, along with Gonorrhea and Chlamydia testing where indicated by CDC criteria.

Vaccination review and administration.

The civil surgeon compares your records against the CDC's age-appropriate requirements and administers anything missing. Only a civil surgeon can complete the vaccination section of the form — if you get a shot elsewhere, you must return with proof so it can be recorded properly. One helpful note: COVID-19 vaccination was removed from the required immigration vaccination schedule in 2025 and is no longer needed for Form I-693.

How Many Visits, and How Long

Most applicants need two touchpoints, though not always two full appointments.

The first visit covers the exam, the blood draw, and any vaccines. IGRA results typically return within a few business days. Some offices complete and seal the form without requiring you to come back in person; others schedule a short return visit. If your IGRA is positive and a chest X-ray is needed, add time for imaging.

Plan for roughly one to two weeks from your first appointment to a sealed envelope in hand — sometimes longer if you need a chest X-ray or a multi-dose vaccine series.

What It Costs

USCIS charges no filing fee for Form I-693 itself. The cost is entirely what the civil surgeon's office charges, and USCIS does not regulate those fees. Nationally, applicants typically pay somewhere between two hundred and five hundred dollars for the exam and required lab work, with vaccines billed separately on top.

Three factors drive most of the variation:

• How complete your vaccination records are. This is the biggest single variable, and the one you control.
• Whether you need a chest X-ray following a positive TB result.
• Whether the practice performs labs and vaccinations on site or refers you out, which adds both cost and time.

At e7 Health, the exam, the blood work, and the vaccines all happen in one office. That matters more than it sounds like it does — being sent to a separate lab and a separate pharmacy is where most of the delay in this process comes from.

The Sealed Envelope Rule

When your exam is complete, the civil surgeon places Form I-693 in an envelope and seals it. Do not open it. A broken seal voids the document, and USCIS will issue a request for evidence for a properly sealed replacement.

A reputable office will also give you an unsealed copy for your own records, so you can review the form and keep the information without touching the official envelope. Ask for it if it is not offered.

Timing and Validity: Check Before You Schedule

The rules governing when Form I-693 must be signed and how long it remains valid have been revised several times in recent years, and much of the guidance circulating online is out of date. USCIS also now generally requires Form I-693 to be filed together with Form I-485 rather than provided later.

Because these requirements affect your filing strategy rather than the medical exam itself, confirm current timing rules on the USCIS website or with your immigration attorney before scheduling. We will complete your exam correctly whenever you come in; when to come in is a question for your legal timeline.

Three Mistakes That Force a Second Exam

• Using a physician who is not a USCIS-designated civil surgeon
• Opening the sealed envelope
• Having the exam completed on an outdated edition of Form I-693

Every one of these is avoidable, and every one of them means paying for the exam twice.

Schedule Your Immigration Medical Exam in Las Vegas

e7 Health has provided immigration medical exams to the Las Vegas community for more than two decades. Our designated civil surgeon completes the exam, and our on-site lab and full vaccine inventory mean you are not sent across town between appointments. We offer same-day and next-day scheduling, and our staff can walk you through exactly what to bring before you arrive.

This article is provided for general informational purposes and is not legal advice. USCIS requirements change; verify current requirements at uscis.gov or consult a licensed immigration attorney regarding your specific case.

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