Do I have to finish an entire vaccine series before my Form I-693 can be completed?

No. For a vaccine you are missing, the civil surgeon generally gives one dose of that vaccine at the exam and records it. You are not expected to complete a multi-dose series before the form is signed; later doses are marked as not yet due because of the required time interval. You should still finish the series afterward with your own doctor or a pharmacy, because partial protection is exactly that: partial.

Can I get my missing vaccines at a pharmacy or with my own doctor instead?

Often, yes, but ask the clinic before you do. The civil surgeon has to review written proof of every dose, so any shot you get elsewhere must come with a record showing the vaccine, the date, and who gave it. Some clinics give vaccines on site, while others refer you out and ask you to return with the record. A return trip can add days to finishing your form, so it is worth knowing which applies before you book.

Is the COVID-19 vaccine required for the immigration medical exam in 2026?

No. The COVID-19 vaccination requirement for Form I-693 ended on January 22, 2025, and it does not apply to exams done now. Many websites, and some older checklists from attorneys and community groups, still list it because they have not been updated. If a clinic tells you COVID-19 vaccination is required for your immigration medical exam, ask them to show you the current CDC Technical Instructions.

Immigration Medical Exam Vaccination Requirements (2026)

Q: What if a required vaccine goes against my religious beliefs?

There is a process for that, but it is a legal one, not something the civil surgeon can grant at the exam. An objection based on religious beliefs or moral convictions is handled as an individual waiver that you request from USCIS, generally with Form I-601, and USCIS decides it. The standards are specific and the paperwork matters, so speak with an immigration attorney before your appointment rather than after.

For most people, the vaccine section of the immigration medical exam (often called the green card medical exam) is less about getting a long list of shots and more about proving the shots you already had. The civil surgeon compares your written records against a list CDC sets, gives or refers you for what is missing, and records a waiver code for anything that doesn’t apply to you. Here is how that works, and where people most often get stuck.

The vaccines on the CDC list

CDC’s Technical Instructions for civil surgeons require age-appropriate vaccination against these diseases:

Diphtheria, tetanus and pertussis
Polio
Measles, mumps and rubella
Rotavirus
Haemophilus influenzae type b (Hib)
Hepatitis A
Hepatitis B
Meningococcal disease
Varicella (chickenpox)
Pneumococcal disease
Influenza

“Age-appropriate” is the important phrase. No one needs all of them. Which ones apply to you depends on your age on the day of the exam and on what CDC’s routine immunization schedule recommends for that age.

Which vaccines apply at which age

The table below is a general guide. Exact age cutoffs are set by the current CDC schedule, and the civil surgeon applies them to your specific age and history.

Vaccine	Who it generally applies to	Notes
Diphtheria, tetanus, pertussis (DTaP, Tdap or Td)	All ages, starting in infancy	Children receive DTaP; adolescents and adults receive Tdap or Td
Polio	All ages from 2 months, including adults	Adults who can’t document a childhood series receive a dose; titer (all three types) accepted
Measles, mumps, rubella (MMR)	Children from about their first birthday, and adults per CDC criteria	Live vaccine; not given during pregnancy
Varicella	Children from about their first birthday, and adults without evidence of immunity	Live vaccine; not given during pregnancy
Rotavirus	Infants only	Oral vaccine with strict age limits
Hib	Infants and young children	Generally not required for older children or adults
Hepatitis A	Children and adolescents, per CDC schedule	Titer accepted as proof of immunity
Hepatitis B	Children and adolescents, and other ages per CDC schedule	Titer accepted as proof of immunity
Meningococcal	Adolescents, per CDC schedule	Timing depends on age at exam
Pneumococcal	Young children and older adults	Adult age threshold follows the current CDC schedule
Influenza	Everyone 6 months and older	Required only when the exam falls between September 1 and March 31

If the table and your clinic disagree, the clinic is working from the current Technical Instructions and your exact age, which is what counts.

COVID-19 is no longer required

The COVID-19 vaccination requirement ended on January 22, 2025. It no longer appears on the list above and does not apply to any exam done today. A surprising number of websites still list it, so if you have been told otherwise, the information is out of date. You can check the current list yourself on CDC’s civil surgeon vaccination page.

Influenza depends on the calendar

The flu vaccine is only required during flu season, which civil surgeons treat as September 1 through March 31. An exam in June does not require a flu shot; an exam in November does. Outside those months, the surgeon records that the vaccine doesn’t apply, and nothing further is needed.

If you’ve lost your vaccination records

This is one of the most common worries, and it usually has a manageable answer.

Look before you give up. Records from a childhood clinic, a school, a previous visa medical exam, a home-country health booklet or a state immunization registry all count. Foreign-language records are acceptable with a reliable English translation, which CDC makes the applicant’s responsibility; bring what you have even if it is handwritten or partial. What does not count is a recollection. The civil surgeon needs written documentation of each dose.

Blood tests can replace missing records. For some diseases, a lab test that shows you are already immune (often called a titer) is accepted in place of a vaccine record. CDC accepts this evidence for:

Measles, mumps and rubella
Hepatitis A
Hepatitis B
Polio (all three types)
Varicella

For an adult who grew up with these diseases or was vaccinated long ago, titers can mean fewer shots. The trade-off is a blood draw and time waiting for results, and each titer is usually a separate lab charge.

Otherwise, one dose at the exam. Where there is no record and no titer option, you receive a dose of the missing vaccine. You generally do not need to finish a whole series before the form is completed; the remaining doses are recorded as not yet due.

This is where many applicants lose time. Some clinics don’t give vaccines on site and send people to a pharmacy with instructions to come back once they have the shots. That works, but it is a second trip and it delays your sealed form. Ask how vaccines are handled when you book.

Blanket waivers: when a vaccine doesn’t apply to you

When a required vaccine is not medically appropriate for you, the civil surgeon records a blanket waiver on the form. You don’t file anything, and there is no fee to USCIS. The categories are:

Not age-appropriate. The vaccine isn’t recommended at your age, for example rotavirus for an adult.
Contraindicated. A medical reason makes the vaccine unsafe for you, such as a prior severe allergic reaction, or pregnancy for live vaccines like MMR and varicella.
Insufficient time interval. You’ve started a series, and the next dose isn’t due yet.
Not routinely available. The vaccine isn’t available in the United States or is in shortage.
Not flu season. The exam is outside September 1 to March 31.

Blanket waivers are routine. They are part of a correctly completed form, not a red flag.

Individual waivers for religious or moral objections

A different situation arises when a vaccine is medically appropriate but you object to it on the basis of religious beliefs or moral convictions. The civil surgeon cannot grant this. It is an individual waiver that you request from USCIS, generally using Form I-601, and USCIS decides whether to approve it. USCIS applies its own standards to these requests, and a refused vaccine without an approved waiver can affect your case.

Because this is a legal process with real consequences, talk to an immigration attorney before your appointment. Tell the clinic in advance too, so the form is completed accurately.

What vaccines usually cost

Vaccines are usually priced separately from the exam fee, and titers are usually separate lab charges. Two applicants at the same clinic can pay very different totals depending on their records. Before any vaccine is given, ask what you need and what each one costs. Each clinic in our network publishes its price and what it includes on its clinic page. Our cost guide explains the common add-ons.

Before your appointment

Gather every record you can find and bring them all, in any language. Our checklist of what to bring covers the rest. For an overview of the whole visit, see our immigration medical exam guide. When you’re ready, find a clinic near you.