Immigration Medical Exams
Rebecca N. Pirela, M.D. USCIS Civil Surgeon
1417 N. Semoran Blvd. Suite 101. Orlando, FL 32807
"We take pride in our work and guarantee that your immigration medical report will satisfy all USCIS/US Immigration requirements"
DID YOU SCHEDULE YOUR APPOINTMENT YET? THEN, YOU MUST ANSWER THE FOLLOWING QUESTIONS:
Send all your answers to: email@example.com in no more than 48 hours. If not received your appointment will be CANCELLED.
1. Last Name (All as they appear on your PASSPORT):
2. First and middle name(s):
3.Date of birth (MM/DD/YYYY):
4. Home Address (not PO BOX) to be use on your USCIS medical report:
5. Apartment or Unit number (if any):
6. Country of birth:
7. City or town of birth (as it appears on your Passport):
8. Do you have an employment authorization card or have you received any USCIS letters? Yes or No?
9. If you replied “YES” on question #8, please write down your Alien number (9 digits):
10. Passport number:
11. Passport expiry date (write the month in words)
12. Country of passport:
14. If you have Health insurance, what is the name of your insurance carrier?
15. *Do you speak and understand English fluently? Would you need an interpreter if a USCIS officer were to interview you face to face?
16. What is your phone number?
17. Have you ever been sick with the “chicken pox”/Varicella?
18. Have you ever been sick with COVID?
19. Have you been vaccinated against COVID? If so, when?
*if you do not speak English fluently, you will be required to bring an interpreter. USCIS strictly requires that an interpreter SIGNS the I-693 Form on the day of your appointment.