If you’re applying for a U.S. green card, you’ll get your required vaccines through a USCIS-designated civil surgeon, a doctor specifically authorized to perform immigration medical exams. You can also get some or all of your vaccines beforehand at a local pharmacy, health department, or primary care office to potentially save money, but the civil surgeon is the one who reviews your records, confirms you’re up to date, and signs off on Form I-693.
How to Find a Civil Surgeon
USCIS maintains a searchable list of designated civil surgeons across the country. You can find one near you using the Civil Surgeon Locator tool on USCIS.gov or by calling the USCIS Contact Center at 1-800-375-5283. The list updates weekly, so check that any doctor you’re considering is still on it close to your appointment date. It’s also worth confirming directly with the doctor’s office before booking.
Civil surgeons are typically family medicine doctors, internists, or physicians at immigration-focused clinics. Not every doctor can perform an immigration medical exam. Only those with an active USCIS designation can complete and sign Form I-693, the official medical examination report submitted with your green card application.
Which Vaccines You’ll Need
The CDC sets the vaccine requirements, and the list depends on your age. As of March 2025, adults between 18 and 64 need the following:
- Tetanus, diphtheria, and pertussis (Tdap/Td): Required if you don’t have a documented primary vaccination series.
- Polio: Required if you lack a documented primary series.
- Measles, mumps, and rubella (MMR): Required if you were born in 1957 or later.
- Hepatitis B: Required for everyone through age 59.
- Varicella (chickenpox): Required for adults under 65.
- Influenza (flu shot): Required when flu vaccine is available in the country where the exam takes place. This is seasonal, so timing matters.
Children have additional requirements including hepatitis A, rotavirus, pneumococcal, meningococcal, and Hib vaccines, all following the standard CDC childhood immunization schedule. Adults 65 and older have a shorter list, with influenza being the main requirement and hepatitis B no longer mandatory.
One notable change: COVID-19 vaccination is no longer required. The CDC removed it from the immigration vaccine requirements effective March 11, 2025.
Getting Vaccines Before Your Exam
You don’t have to receive every vaccine at the civil surgeon’s office. Many applicants save money by getting vaccinated at a pharmacy (CVS, Walgreens, Costco), their primary care doctor, or a local health department clinic before the exam. Retail pharmacies can administer most adult vaccines, often at lower prices than a specialized immigration clinic, and some are even covered by insurance.
The key is documentation. Bring written proof of every vaccine you’ve received, whether it’s a printout from your pharmacy, a childhood vaccination booklet, or an international immunization certificate (sometimes called a “Yellow Card”). Records in a foreign language should ideally be translated. If you received vaccines abroad, gather whatever official documentation you have. The civil surgeon will review your records and determine what’s still needed.
If you can’t finish a multi-dose series before your exam (hepatitis B, for example, requires two or three doses spread over weeks or months), the civil surgeon can note the doses you’ve received and counsel you to complete the series after arriving in the U.S. through a private doctor or local health department.
What the Exam Costs
Immigration medical exams are almost never covered by insurance. Expect to pay out of pocket. The exam itself typically runs around $200 to $350 depending on your location, with vaccines and lab work charged separately. At one Houston clinic, for example, the base exam costs $250, with antibody blood tests (titers) for MMR running $150 and varicella titers at $145. Any vaccines you’re missing are additional.
Total costs can range from $300 to over $800 depending on how many vaccines and blood tests you need. Getting vaccinated at a pharmacy or health department beforehand, where prices tend to be lower and insurance may apply, can bring down your total bill significantly. Call ahead and ask the civil surgeon’s office for a price list so you know what to expect.
If You Can’t Get Certain Vaccines
There are two recognized grounds for a vaccine waiver. The first is a medical reason: if a vaccine is contraindicated for you due to a health condition, allergy, or pregnancy, the civil surgeon documents this on Form I-693. The second is religious or moral objection. If vaccinations conflict with your sincere religious beliefs or moral convictions, you can apply for a waiver using Form I-601, the Application for Waiver of Grounds of Inadmissibility. This is a separate filing with USCIS and requires a written explanation of your objection.
Waivers aren’t automatic. USCIS reviews each request individually, and a denied waiver can delay or jeopardize your application. If you’re considering this route, it’s worth consulting an immigration attorney to understand the risks.
Preparing for Your Appointment
Bring every vaccination record you have, including childhood immunizations from your home country. Also bring a government-issued photo ID, your immigration case paperwork, and any relevant medical records. If you’ve had blood tests (titers) showing immunity to diseases like measles or chickenpox, bring those results too, as they can substitute for vaccination records in some cases.
The civil surgeon will complete a physical exam, order blood tests for tuberculosis and syphilis, review your vaccine history, administer any missing vaccines (or refer you elsewhere to get them), and then seal Form I-693 in an envelope for submission to USCIS. The completed form is valid for two years from the date the civil surgeon signs it, so don’t schedule the exam too far in advance of your green card filing.