Immigration Medical Exam

The immigration medical exam for your green card (Adjustment of status) in the United States, will be done by our doctor who is authorized by U.S. Citizenship and Immigration Services (USCIS). USCIS designates certain doctors (also known as civil surgeons) to perform the medical exam required for most Green Card applicants.

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General Info

Personal info

EMERGENCY CONTACT

I request that payment of authorized benefits be made to First Care Providers, L.L.C for any service furnished to me by that provider. I authorize any holder of medical information about me to release to the Health Care Financing Administration and its agents any information to determine these benefits payable for related services. This authorization may be canceled on request any time.
This document shows that we have your signature on file and we will submit your insurance claim for services rendered at out office. Please submit your insurance cards for photocopy.

PATIENT MENTAL HEALTH QUESTIONNAIRE (PHQ-9)

Over the last 2 weeks, how often have you been bothered by any of the following problems?

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