Immigration Physical Exam Registration
Registration for individual (or family) for Immigration Physical Exam
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Email *
First Name: *
Middle Name: *
Last Name: *
Mobile Phone:
(By providing the phone number, you agree to receive text messages)
 *
If you have medical insurance, do you want to use your medical insurance for labs and vaccines? *
Interview date with UCIS (if any):
Lawyer's or case worker's name:
Lawyer's or case worker's phone number:
Lawyer's or case worker's email address:
Patient's Full Address:
(Street, apt, City, State, Zip)
 *
Important Information
   1. We can recertify the medical exam result up to 1 year from the date of visit with no additional
cost.
   2. Patient is responsible to pick up the package unless choosing to receive the package by mail.
It may take between 1 - 2 weeks depending on patient’s health condition.
   3. Vaccine requirements depend on timing and lab results. Additional vaccines and/or chest Xray
may be required when lab results completed and when the civil surgeon reviews the final
documents. It’s recommended that you complete the vaccine requirements as soon as
possible. *
Required
The estimated fee for the medical exam is as followed:
   a. $250.00/person for physical Exam
   b. $150/person for labs (your insurance may cover this)
   c. $25 to mail final I-693 package
   d. $5 for physical copy (a copy will be emailed for free)
The total fee does NOT cover chest X-ray (if necessary), or any health treatment resulting of the exam.

No fee for Cash, debit card, or Zelle. All other payment methods incurs an additional 3% of the total transaction.
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Required
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