I-693 Pre-Visit – caringheartsmedicalfoundation

Welcome to your Pre I-693 Visit Assistant. Please be sure to fill this form in its entirety everywhere that it applies to you. This will ensure that you get seamless service. Submission is required at least 24 hours before your scheduled visit.

Family Name (Last Name) *

Given Name (First Name) *

Middle Name

Address Line 1 *

Apartment/Suite/Floor Number (if any)

Apartment Number
Suite Number
Floor Number

Do not check any and move to City, if not relevant to you.

Enter Apartment/Floor/Suite Number Only (if any)

*No special characters allowed please

City *

State *

Zip Code *

Gender *

Male
Female

Applicant's Phone Number *

Applicant's Email Address *

Date of Birth *

2 digit month, 2 digit date, 4 digit year

City/Town/Village of Birth *

Country of Birth *

Alien Registration Number (A-Number) (if any)

USCIS Online Account Number (if any)

Form of Identification to be presented by applicant *

Document Identification Number *

Please enter the document number on your International Passport/ID Card/Passport Card/Driver License/Employment Authorization Number exactly as it appears

Please take a picture of your Identification and Upload here *

Click or drag files to this area to upload. You can upload up to 4 files.

Vaccination Records: History and Evidence

Have you been vaccinated in the past? Depending on your age, USCIS requires different vaccinations. Your vaccination history must be presented to the civil surgeon to review.

Please Upload Copies of your Vaccination Records

Click or drag files to this area to upload. You can upload up to 6 files.

Please take a clear picture of the front and back of all your vaccination records and upload here. The civil surgeon will need to sight the original/physical copy at the time of your visit.

Section II

Applicant's Statement *

I can read and understand English. I have read and understand everything on the I-693 Form
I cannot read and understand English. An Interpreter has read and explained everything on the I-693 Form to me

Please read carefully:

Interpreter's Family Name (Last Name)

Please enter interpreter's details (if any)

Interpreter's Given Name (First Name)

Please enter interpreter's details (if any)

Interpreter's Business Organization Name (if any)

Please enter interpreter's details (if any)

Applicant's Native Language (if using interpreter)

Interpreter's Phone Number

Interpreter's Email Address (if any)

Interpreter's Address Line 1

Interpreter's Address Line 2

Interpreter's Apartment/Suite/Floor Number (if any)

Apartment Number
Suite Number
Floor Number

Do not check any and move to City, if not relevant to you.

Enter Interpreter's Apartment/Floor/Suite Number Only (if any)

*No special characters allowed please

Interpreter's City

Interpreter's State

Interpreter's Zip Code

Applicant's Signature *

Sign your name here please