The Form I-693 immigration medical exam in St. Louis, done right the first time

A green card application can stall on one envelope. Form I-693, the Report of Immigration Medical Examination and Vaccination Record, is accepted by U.S. Citizenship and Immigration Services only from a physician it has designated as a civil surgeon. Get it wrong and you get a Request for Evidence, a return visit and a delayed application.

ImmigrationExam is a private medical practice in St. Louis, next to Lambert International Airport, built to get it right the first time. Dr. Gurpreet Singh Padda, MD, MBA, MHP, the USCIS-designated civil surgeon and owner, performs every examination (background). The practice also performs Form N-648 evaluations for citizenship applicants who cannot take the English and civics tests.

Most exams are completed in a single visit, and most applicants are seen within days. Not sure which form you need? Tap the directory assistant, the light in the corner of the page.

Not a government agency. ImmigrationExam is not USCIS, the Department of Homeland Security or any other agency, and is not affiliated with, endorsed by or operated by one. "USCIS-designated civil surgeon" means a private physician designated to perform the I-693 exam. The practice is not a law firm, gives no legal or immigration advice, and does not file, review or decide applications. Its fees are for medical services, separate from any government filing fee. Official USCIS forms are free from USCIS.

Why does the civil surgeon matter?

Because the designation is only the entry ticket. Dr. Padda is a diplomate of the American Boards of Anesthesiology, Pain Medicine, Interventional Pain Management, Addiction Medicine and Obesity Medicine, a Certified Physician Executive, and a certified MoCA cognitive rater. He earned his MD at the University of Missouri-Kansas City and his MBA at Saint Louis University. He is a DHS-designated USCIS civil surgeon (CS 111051), licensed in Missouri (MD 100572), individual NPI 1427035955.

Your own doctor cannot complete the I-693 unless they hold the designation. They still help: a letter outlining treatment plans, a copy of your history and any old chest X-rays make the exam cleaner. Diabetes, high cholesterol and high blood pressure do not interfere with an application. They are simply documented.

What happens at the exam, step by step?

1. Book. Reserve online or text (314) 886-5902 and staff schedule you, in your language if needed. A $100 scheduling fee holds the slot and is credited toward the $390 exam fee.
2. Check in with documents. Photo ID, vaccination records, and Form I-693 with Part 1 completed and not signed. Ask about Fast Track at the desk if you are on a deadline. There are dedicated New Patient, Fast Track and Standard check-in lanes.
3. History and physical. The exam checks only what immigration rules specify: infectious diseases of public health concern, substance use and certain mental health conditions. It is not a general checkup.
4. Vaccination review. U.S. and foreign records are validated dose by dose against the CDC's age-specific requirements, so you never repeat a shot you already have.
5. Labs. A tuberculosis IGRA blood test from age 2, plus a syphilis blood test and a gonorrhea urine test as required by age, drawn on site. No separate lab trip.
6. The sealed envelope. Arrive with paperwork, testing and immunization records complete, and the form is completed, signed and sealed that day. Otherwise it is sealed as soon as everything returns.

Plan 2 to 6 hours for the appointment.

What vaccines does a green card require?

It depends on your age on exam day, under the CDC Technical Instructions for Civil Surgeons effective March 11, 2025:

• Polio (IPV) from 2 months of age, adults 65 and older included, since May 1, 2024. One dose unless a complete series is documented. A remembered childhood shot does not count, and neither does oral polio vaccine given after April 1, 2016. A titer must cover all three poliovirus types.
• DTaP for children 2 months through 6 years. Tdap or Td from 7 years, required from 11 upward.
• MMR from 12 months, if born in 1957 or later. Titer accepted.
• Varicella from 12 months. Disease history or titer can qualify.
• Hepatitis B from birth through 59, expanded from 18 in April 2022 and often missed by adults. Titer accepted.
• Hepatitis A from 12 months through 18 years, two doses.
• Meningococcal 11 through 18. Hib 2 through 59 months. Rotavirus 6 weeks through 8 months. Pneumococcal 2 through 59 months and 65 and older.
• Influenza only if the exam falls between September 1 and March 31.
• COVID-19: not required. USCIS waived it for adjustment of status on January 22, 2025, and the CDC removed it on March 11, 2025.

Not age-appropriate, contraindicated, too soon after a prior dose, or flu out of season: the civil surgeon documents the waiver on the form. Pregnancy is a precaution for IPV.

What if my records are from home, or missing?

Foreign records count if they can be validated. Bring official records with a certified English translation. No records at all? You are not turned away. The needed vaccines are documented, and you complete them at the office or at a county health department, often the same week. Low-cost options: St. Louis County Department of Public Health at 6121 N Hanley Rd, Berkeley; St. Charles County Department of Health; Madison County Department of Health in Illinois. Bring the record of each new dose so it goes on your form the same day.

What do I bring?

• Form I-693, Part 1 completed, not signed. The practice offers it online to fill in before your visit.
• Government photo ID: passport, ID card or driver's license.
• For children under 14: a birth certificate or similar showing name, date and place of birth, and both parents' full names.
• Immunization records with official English translation.
• Medical history, prior chest X-rays and your doctor's treatment-plan letter.
• Your insurance card, if any.
• An interpreter who can speak, read and write English, if needed.
• Payment: cash, check or card, due at the visit.

Use the current edition of the form. USCIS rejects expired editions. The practice verifies the edition before sealing.

How much does the I-693 exam cost?

$390 flat. A $100 non-refundable scheduling fee at booking, $290 at the visit. That is the full professional fee. No facility fee. No consultation fee. No USCIS filing fee for the I-693 itself. The $390 is not billed to insurance.

Three costs sit outside it, because the practice does not set them:

• Laboratory testing. What USCIS requires depends on age and history, so some applicants need less than the full panel. Quoted at your visit once the required tests are known. Use your own insurance and you pay its negotiated rate.
• Chest X-ray. Only after a positive or borderline TB result. Quoted if required, or billed to your insurance.
• Vaccinations. Per dose, only for doses genuinely missing. Complete records keep this at zero.

Specialty consultations, if medically required, are billed separately.

When does the $190 follow-up fee apply?

Only when another in-person evaluation is actually needed, for one of two reasons:

• Medical. Labs or records that arrived late, or a vaccine dose completed afterward. A result suggesting a communicable disease such as tuberculosis or syphilis that needs treatment or further evaluation; these are reportable, so the county health department is notified and reporting flows to the CDC. Or history and exam suggesting a major life-threatening illness, where the practice is required to engage an independent consultant for a consultative report.
• Unprepared. Arriving without complete paperwork, testing or immunization records.

If your initial presentation is fully complete, there are no follow-up fees.

How long until the form is sealed?

It can be the same day. Your Form I-693 is completed and sealed at whichever visit your paperwork, testing and immunizations are all complete.

Lab results typically take 2 to 5 business days. A chest X-ray adds several days. A finding needing treatment or a consultant's report can take longer. The practice texts you the moment the form is ready. Facing a Request for Evidence or an interview date? Text (314) 886-5902 with the deadline. Time-sensitive cases are prioritized.

How is the form sealed?

In person, every time, because a signature completed in advance is prohibited:

1. Dr. Padda reviews your results with you and validates your photo ID.
2. He directly observes your wet signature and signs his validation at the same time.
3. He makes two copies, seals the original and signs across the seal.
4. You leave with the sealed original for USCIS and an unsealed copy.

What is the money-back guarantee?

If USCIS rejects your I-693 solely because of the practice's paperwork error, and you met every vaccination and medical requirement with no other defects, you get a full refund. No fine print. Submit a complete copy of the USCIS rejection letter or notice showing no other errors. It covers the I-693 exam only, not N-648 evaluations or lab and radiology fees.

What is the N-648 disability waiver evaluation?

Some citizenship applicants cannot learn English or civics because of a medical condition lasting 12 months or more: dementia, stroke, developmental disability, severe psychiatric illness. Form N-648 lets a licensed physician certify it so the applicant is excused from those tests. The practice launched the service in July 2026.

The line is drawn hard. For memory and thinking, only severe memory loss or severe cognitive impairment meets medical necessity. Mild or moderate does not qualify, and those cases are declined. Only USCIS decides whether an N-648 is sufficient, and no physician can guarantee approval.

1. Records review. Neurology, psychiatry, primary care, imaging and testing records are screened before anything is scheduled. No medical merit, no acceptance, and you are told why. No records usually means no case.
2. Evaluation. In person, with standardized instruments built for patients with limited formal education: the Montreal Cognitive Assessment, the VA Saint Louis University Mental Status exam, and in some cases Cognivue computerized testing, administered in your language through an interpreter. Interpreter fees are paid by the applicant.
3. Deliverables. A physician-signed Form N-648 on the current edition, as a PDF, plus a plain-language medical summary on letterhead.
4. Revisions. USCIS-requested amendments within 12 months of the evaluation. Older cases, or ones first evaluated elsewhere, need a full re-evaluation.

A $100 non-refundable scheduling fee reserves the N-648 appointment and is credited toward N-648 fees.

Where is ImmigrationExam?

4477 Woodson Rd, Suite 102, St. Louis, MO 63134, directly next to the airport. Look for the gray building with the orange entrance, then the accessibility ramp and the glass doors. Call (314) 960-9100 or text (314) 886-5902. The practice serves applicants in English, Spanish, Hindi, Chinese, Arabic and Vietnamese.

Dr. Padda also serves as Medical Director of Valor Villages, a separate St. Louis charity. The practice sits on the pain and metabolic medicine hub.

Frequently asked questions

Should I sign Form I-693 before the appointment?

No. Complete Part 1 but wait to sign until the civil surgeon instructs you. A premature signature can invalidate the form.

Will I need a chest X-ray?

Probably not. It is required only when the TB blood test is positive or borderline, and most applicants never need one.

Can I use my own insurance?

For labs and imaging, yes, at your insurer's negotiated rate. The $390 exam fee is not billed to insurance.

What happens if a test comes back positive?

A positive or borderline TB result needs a chest X-ray. A communicable disease finding needs treatment or further evaluation before sealing, and it is reported to the county health department.

Can any doctor fill out an N-648?

It must be a licensed physician who evaluated you. Here Dr. Padda, USCIS-designated civil surgeon CSID 111051 and MoCA-certified rater, performs the whole evaluation himself, including the cognitive testing he is certified to score.