I-693 Signature Requirements: Who Signs, What Counts
Three people can sign Form I-693: you (the applicant), the civil surgeon, and any other physician who evaluated you as part of the exam. Each signs their own section, in original handwritten ink, after the exam is complete. Stamps and typed names do not count. A signature that is missing, in the wrong place or made in the wrong order can lead to a Request for Evidence (RFE), which can delay your green card case by weeks or months.
This guide explains each signature, the timing rules, what USCIS accepts as a valid signature, and how to check your form before you seal it into your filing.
TL;DR
- The applicant, the civil surgeon and any referral physician each sign their own part of Form I-693. USCIS policy says you should not sign until the civil surgeon tells you to.
- USCIS does not accept stamped or typewritten names in place of signatures. Copies are acceptable only if they reproduce an original handwritten ink signature.
- The old 60-day rule is gone. The civil surgeon signs after the whole exam is finished, and you do not need to file within 60 days of that signature.
- The civil surgeon gives you the completed form in a sealed envelope. Do not open or alter it if you file by mail.
Table of Contents
- Who signs Form I-693
- What counts as a valid signature
- When the civil surgeon must sign
- Signed, then sealed: the envelope rules
- Does USCIS check signatures?
- A checklist before you leave the clinic
- Our perspective: signature problems are rarely about the signature
- Getting your I-693 signed and sealed correctly
- Common signature problems and what to do
- FAQ
- Sources
Who signs Form I-693
USCIS policy requires the applicant, the civil surgeon, and any other health care provider who evaluated the applicant as part of the exam to sign. In practice the form has these signature points:
| Signer | What they sign | When |
|---|---|---|
| Applicant | The applicant’s statement, certification and signature section | At the civil surgeon’s office, when the surgeon tells you to |
| Civil surgeon | The civil surgeon’s certification | After the entire exam, including labs and vaccine review, is complete |
| Referral physician | The relevant section, if you were referred for a specific evaluation | After that evaluation |
These roles come from the USCIS Policy Manual chapter on reviewing medical examination documentation.
The applicant’s signature
The policy manual says you must sign and date the applicant’s section, and that you should not sign until the civil surgeon instructs you to. The reason is practical. The surgeon confirms your identity and walks you through the certification before you attach your name to it. A form you pre-signed at home, or signed before the surgeon asked, is the kind of form a careful clinic will have you redo on a fresh page.
The form also carries a consent element: by signing, you authorize the release of medical information to USCIS. If you want more detail on that statement, see our guide to giving consent on Form I-693 (in Spanish).
Children and people who cannot sign for themselves
The Form I-693 instructions say a parent or legal guardian may sign on behalf of a person under 14. A legal guardian may sign for a mentally incompetent person. For a family exam, each person’s form needs its own correct signature, so bring the guardian with valid ID for any child.
The civil surgeon’s signature
Only a USCIS-designated civil surgeon can complete the certification. The surgeon signs once the whole exam is done: physical, required lab results, and the vaccination review. A surgeon who signs while results are still pending creates a form that is incomplete in substance, even if the signature itself looks fine.
A referral physician
If you are referred out for a Class A or Class B condition follow-up, such as a test or specialist evaluation, the evaluating physician signs the appropriate section. The civil surgeon then incorporates the findings. If your form comes back with a referral section blank, ask your civil surgeon before you file.
What counts as a valid signature
This is where most confusion happens, because the rules differ slightly between a stamp, a scan and an e-signature.
Original handwritten ink
The form instructions state that USCIS does not accept stamped or typewritten names as signatures. The policy manual adds that the civil surgeon’s signature must be original; stamps, substitutes and copies of the original signature are not acceptable. There is a narrow exception: blanket-designated health departments and certain military physicians performing specific exams may use a stamped signature for their portion, as the Form I-693 instructions detail. A private civil surgeon’s office does not fall under that exception.
Photocopies and scans
The same instructions say USCIS accepts photocopied, faxed or scanned copies of original forms that contain a handwritten ink signature. The USCIS Policy Manual chapter on signatures agrees, with a warning: USCIS may ask for the original wet-ink document at any time. Keep the original.
A copy of a signed page is fine. A signature that was cut out, pasted or inserted onto a blank form is not.
Images of signatures and e-signatures
A 2026 USCIS Policy Alert, PA-2026-03, clarifies that an image of a handwritten signature affixed separately to a request, physically or electronically, is not a valid signature. It also says that for electronic submissions, only e-signatures provided directly through a USCIS online account during filing are accepted.
For Form I-693 that means one thing: the medical form itself should carry real ink from each signer. If you file your I-485 online, you still need that ink-signed medical form. You upload it, but you do not sign it electronically. We cover how the paper and digital paths fit together in I-693 sealed vs. electronic.
Does the signature have to be legible?
No. The policy manual says a valid signature does not need to be cursive or legible. It may even be an “X” or a symbol, as long as it is consistent with how the person normally signs. What matters is that the mark is genuinely handwritten and is the signer’s own.
Do you need to notarize anything?
No. The I-693 does not require a notary, and notarizing copies does not make them more acceptable. Our short explainer on why notarizing I-693 paperwork is not needed covers the details.
When the civil surgeon must sign
For years, USCIS required the civil surgeon’s signature to be dated no more than 60 days before you filed the underlying application. USCIS removed that requirement in 2023. The policy manual now says the surgeon signs after completing the entire exam.
Two related timing points:
- Validity. According to the policy manual, forms signed on or after November 1, 2023 generally remain valid only while the associated application is pending. Earlier forms retain evidentiary value for two years. The form instructions also describe two years from the surgeon’s signature as the validity period for the older rule, so check the edition and signature date you hold.
- Filing with your I-485. USCIS now says that when you file Form I-485 you must also submit Form I-693. See the USCIS page for Form I-693 for the current filing instructions.
The signature date therefore matters less for a deadline than it once did, but it still matters for confirming which rule applies to your form. If you are unsure about the edition of your form, read how to avoid RFEs by checking the edition, vaccines and seal.
Signed, then sealed: the envelope rules
A signed form is only half of what USCIS looks for. The form instructions say the civil surgeon must give you the completed I-693 in a sealed envelope, and you must submit it sealed. USCIS will return it if it is not sealed or if the envelope is opened or altered. The policy manual tells officers to issue an RFE when a form or envelope looks tampered with.
There is one important difference for online filers. USCIS states that if you file Form I-485 online, you open the sealed envelope and upload the completed form. In that case, you must keep the original form and envelope until a final decision on your I-485, because USCIS may ask to see them at an interview or request the originals as evidence. If you file by mail, submit the form in its original sealed envelope.
If your envelope is damaged or you opened it by accident, do not try to tape it shut. Contact the clinic that issued it. We keep a replacement sealed envelope service for this situation.
Does USCIS check signatures?
Yes. The policy manual explains that officers review signatures on photocopied submissions to confirm they look like real handwritten marks rather than mechanical reproductions. A stamp, a typed name or a visibly digital pasted image is a red flag. A normal photocopy of an inked signature is not.
What happens when a signature is missing or unacceptable depends on the case. Most often the result is an RFE asking you to correct the form, and sometimes the filing is returned. The fix usually requires the civil surgeon to correct or reissue the form, because you cannot sign or alter the surgeon’s section yourself. For more on this, see our guide to I-693 corrections through your civil surgeon.
A checklist before you leave the clinic
Take two minutes at the desk. It costs far less than an RFE.
- Your signature and date are in the right box. You signed because the surgeon told you to, not earlier.
- The surgeon’s signature is wet ink. Not a stamp, not a printed name.
- Every page that requires a signature has one. Including any section for a referral physician, if you were referred.
- The vaccination record and lab results are complete. The surgeon should not have signed with items pending.
- The envelope is sealed and intact. Do not open it unless you are uploading with an online I-485.
- You have a personal copy. If you made a copy of a signed page, it is a copy of the original ink, not a rebuilt page.
- Names and dates match your passport and your other filings.
Our perspective: signature problems are rarely about the signature
We have performed only immigration medical exams since 2007, and we do not do primary care, urgent care or sick visits. That narrow focus shows what goes wrong. Applicants rarely fail because they could not sign their name. They arrive with a form someone else began, a form signed in the wrong order, or a form where the vaccination section was never reconciled before the surgeon signed.
We frequently help applicants who have run into delays, errors, incomplete vaccination documentation or problems with exams done elsewhere. In those cases, the signature is the symptom. The real problem is that the exam, labs and vaccine review were not finished before anyone signed. Our process is built to complete everything in one place, and we run an internal quality review so the I-693 is right the first time.
Two habits prevent most of these problems. First, do not sign anything ahead of time. Second, ask the surgeon to show you the completed signature page before it goes into the envelope. A good clinic will not mind.
— ImmigrationMedicalExams Medical Team
Getting your I-693 signed and sealed correctly
Our practice offers the civil surgeon exam, required laboratory testing, vaccine review and any required vaccinations, and preparation of the I-693, all at one location serving Southern California. Our flat-package approach is designed to limit surprise costs.
Standard processing takes about 3 days, and a 2-day expedited option is available. You can pick the standard 3-day exam or the 2-day expedited exam, and schedule online at any hour. For the step-by-step flow, read how online scheduling leads to a sealed I-693. If you are not sure what to expect on the day, see what happens at an immigration medical exam.
Common signature problems and what to do
| Problem | Why it matters | What to do |
|---|---|---|
| Stamped or typed civil surgeon signature | USCIS requires an original signature, with narrow health department and military exceptions | Ask the surgeon to re-sign in ink or reissue the form |
| You signed before being told | Policy says to wait for the surgeon’s instruction | Have the clinic correct it, rather than writing over it |
| Pasted image of a signature | PA-2026-03 says separately affixed images are not valid | Use the original ink-signed form |
| Opened or altered envelope | USCIS can return it or issue an RFE | Request a replacement from the issuing clinic |
| Surgeon closed or moved practice | You still need the signed results | See how to recover results if a civil surgeon closes |
| Reusing a form from a closed case | Results generally do not carry over to a new filing | Read about why I-693 results cannot follow a closed case |
FAQ
Can I sign Form I-693 electronically?
No, not for the medical form itself. USCIS requires handwritten ink signatures, and the 2026 policy alert says only e-signatures given directly through a USCIS online account count for electronic submissions. Even when you file the I-485 online, you upload the ink-signed I-693 that the civil surgeon sealed.
Can a photocopy of my signed I-693 be submitted?
USCIS accepts a photocopy, scan or fax of an original form that carries a handwritten ink signature, and it may ask for the original at any time. For mailed I-485 packages, however, the form must go in its original sealed envelope. Keep the original either way.
Who signs for a child?
A parent or legal guardian may sign for a person under 14, according to the Form I-693 instructions. Bring the child and the signing adult with ID. The civil surgeon still signs the examination certification.
Does the civil surgeon have to sign within 60 days of my filing?
No. USCIS removed the 60-day rule in 2023. The surgeon signs once the entire exam is complete, and the signature date now mostly determines which validity rule applies to your form.
Does my signature have to be neat?
No. The USCIS Policy Manual says a signature need not be cursive or legible, as long as it is a genuine handwritten mark consistent with how you normally sign.
Sources
- USCIS Policy Manual, Volume 8, Part B, Chapter 4: Review of Medical Examination Documentation
- USCIS Form I-693 Instructions
- USCIS Policy Manual, Volume 1, Part B, Chapter 2: Signatures
- USCIS Policy Alert PA-2026-03: Signature Requirements
- USCIS Policy Alert: Removal of the 60-Day Rule
- USCIS: Form I-693 page