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Instructions for I-693 Form

I-693 Form:

  • The I-693 Form is included in the packet you pick up at our Clinic. 
  • You will bring this form back to the Clinic on your appointment day. 
  • Please fill out parts 1 – 4. DO NOT SIGN THE FORM. Do NOT fill out parts 5 – 11. 
  • Fill out your name and A-number (if you have one) which are on the top part of each page. 
  • If you are able to read & write English, do not fill out portions for “Interpreter” and “Preparer”.
  • If you are unable to read and write in English, you will need an Interpreter and Preparer; please bring the person you have chosen to do this to your appointment. If you do not have an Interpreter and Preparer, one of our staff will be available to assist. Fee for that function is $50 which you may pay on the day of your appointment. The I-693 Form will be completed on the day of your appointment and given to you that day.

Laboratory Tests:

When you come to the Clinic to pick up your packet and instructions, the assistant will include an order for any laboratory test that you need. The laboratory test may take anywhere from 3 days to 2 weeks to provide us with results, so we recommend you get this done as soon as possible. The cost of the laboratory tests is included in our fee, do not pay the lab.

Immunizations:

  • If you have a record of vaccinations please bring it to your appointment.
  • If you do not have a record of vaccinations, we will provide an order for specific lab tests for proof of immunity. Please let us know if this is the case when you come to pick up your instructions so the assistant can include the lab order in your packet. If you do not have an immunization record and do not have laboratory proof of immunity, we can administer the missing vaccines. If you choose not to be vaccinated you may decide to file for a Waiver with USCIS and provide this to the medical examiner or civil surgeon.
  • At this time, two Covid vaccines are being required before completing the I-693. Only one dose if J&J Janssen – (can be obtained at local pharmacy). If the Covid-19 vaccine you received was “Bivalent” (any brand) only one dose required.
  • Vaccines required will be in accordance with current ACIP and CDC Requirements in accordance with age and immunity status. 
  • Any additional vaccines required can be administered at our office; you may inquire as to the current price. 

What to Bring to Your Appointment:

  • Form I-693 which we provided to you, completed as per above instruction.
  • A government-issued photo ID (Driver’s License, Passport, Green Card, or State Photo ID).
  • Medical Records, Vaccination Record, Medical History Sheet.
  • A translator if you do not speak English. Payment for translation services if you wish our staff to provide the service.
  • Payment for any vaccines you wish to have us administer. 
  • Payment for Medical Exam & Lab Fees – due on day of exam

What Happens at Your Appointment

  • The US Civil Surgeon will review your medical history, your medical questionnaire, your laboratory results, and your vaccination history with you and will perform a physical exam.
  • Medical referrals and further medical evaluations may be requested, depending on review of the applicant’s medical situation. 
  • This information will be recorded on the I-693 Form, everyone will sign and you will be given the completed form in a sealed envelope. 
  • Do not open the sealed envelope.
  • It is your responsibility to submit the sealed envelope with I-693. Your attorney may assist you. It cannot be submitted by a medical provider or Clinic. 

We hope this information has been helpful. If you have any questions please call the Clinic: (941) 923-3667.