Please download the pdf form, fill out these two pages and bring with you along with a copy of your ID and vaccination records.

Patient Information Intake for Immigration Examination (pdf)


Immigration Exams


Please call us for a FREE estimate: 213-622- 3100.

emaElite Medical Clinic offers an immigration medical exam by Dr. Kashani, who is an approved civil surgeon of the Bureau of Citizenship and Immigration Services. So, please come in for a free estimate where our staff will go over your medical records and explain in detail what you are still required from the USCIS. 


Immigration Physical Examination is $350 and includes:

  • Basic Physical Examination
  • Vaccination status verification
  • Tuberculosis Blood Test (Quanteferon)
  • RPR (syphilis) lab test
  • Gonorhea (urine) testing
  • Certified and Sealed I-693 form
  • Patient copy of I-693 form


Vaccines or Xrays will be an additional charge.

Additional services that might be require such as Chest X-Ray, blood titers and vaccinations are not included in the above price, but they are offered and can be completed at our office for an additional fee.

If you have had all your vaccinations and do not have proof of receiving the vaccinations, we can check your blood titers to check for immunity. Please note that if the blood work shows you are not immune you will need to pay the additional fee for the vaccinations. 

MMR Titer (results available in 7 days) $125.00

Varicella Titer (results available in 7 days) $120.00

Quanti-Feron Gold TB Test

If you have a PPO insurance and have not had your yearly physical, we can use your insurance to cover the blood work, TB test and/or vaccinations. Your PPO insurance does not cover the cost of the  I-693 examination. 

We do not accept HMO or Medi-Cal insurance for the immigration examination.  


What the Patient Needs to Bring to the First Appointment:

Currently active Government issued ID with picture. Passport preferred.

Driver’s license, Military ID, and Green Card also acceptable.

• Medical Records translated into English by an official translator (if needed). These Immigration Physical Information Sheet records should include treatment history for Tuberculosis or any other infectious diseases and chest x-ray if you have one.

• Immunization Record translated into English by an official translator (if


Mental Health Records translated into English by an official translator

(if needed).

• The first visit may take 30 minutes to 1 hour or more for the first visit so please plan accordingly. The entire process can take 2-6 days depending on tests and vaccinations. Please complete the forms below prior to the first appointment.

• If you require a translator, please bring one with you. Elite Medical Clinic will not

provide you with one or reimburse for the cost.

• Please bring Form I-693 to your exam and fill out section one in black

ink. Do not sign section 2. The government requires this for completion

of your immigration physical.

Tuberculosis Update:

1. The Tuberculosis blood test is required for applicants age 2 and older. The results are usually ready in  72 hours after the blood is drawn. If the rblood test result is positive then a Chest X-ray will be required at an additional fee.

We cannot accept TB tests from other providers. This must be performed by the Civil Surgeon.

Applicants require proof of vaccinations. The civil surgeon will review your vaccination history to determine if any other vaccines are require and/or if you need any blood titers (laboratory tests that proves if a person has immunity or antibodies for a particular disease). Additional vaccinations and blood titers are offered at an additional fee.

After the immigration physical examination is completed, Dr. Kashani will certify Form I-693 and the intake form (see below) with the test results of the immigration exam and vaccination history in a sealed envelope to present to the Department of Homeland Security. 

DO NOT OPEN THE SEALED ENVELOPE. Turn in the envelope with your immigration application.

A copy of your I-693 report will be provided for you to keep after results have been discussed with the examining doctor. The examination will only be valid up to a year after the immigration exam date. If it has been more  than one year, we will need to repeat another examination, blood and urine test as well as the TB tests. You may need a flu shot if performed during flu season (i.e., October to March).

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Immigration intake forms

Please fill out these two pages and bring to your visit with a copy of your vaccination record. Please note the the final forms will be typed and will be given to you in a sealed envelope. An extra copy will be given for you to keep for your records.

Page 1 of 2 (pdf)


Page 2 of 2 (pdf)