Get Form I-910, Application For Civil Surgeon Designation And ...

Filling out Form I-910, known as the Application for Civil Surgeon Designation, is an essential process for medical professionals seeking to perform immigration medical examinations. This guide provides clear and supportive instructions to help applicants complete the form online effectively.

Follow the steps to complete the Form I-910 online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing your personal information in Part 1. This includes answering yes or no questions regarding previous civil surgeon designations and providing your full legal name, date of birth, and any other names used.
3. In Part 2, list the clinical office locations where you will perform immigration medical examinations. Provide the name, physical address, contact number, and any website or email address related to your practice.
4. Complete Part 3 with your status in the United States. Indicate whether you are a U.S. citizen, lawful permanent resident, or nonimmigrant, and attach any required proof as specified.
5. In Parts 4 and 5, provide your medical degrees and licenses by listing the institutions attended, your degree, and any active medical licenses with their details.
6. Document your professional experience in Part 6, detailing your previous employment as a physician, including employer names, dates of employment, and a verification of your experience.
7. Sign the applicant's statement and certification in Part 7, confirming the accuracy of the information provided and agreeing to abide by regulations.
8. If applicable, fill in the interpreter's information in Part 8, signing to certify their assistance in understanding the application.
9. If someone else prepared your application, complete Part 9 with their contact information and signature.
10. Use Part 10 for any additional information you may need to provide. Clearly label extra sheets as instructed.
11. Finally, review all sections for completeness. Save your changes, and choose to download, print, or share the completed form as needed.

Complete your Form I-910 online to ensure your application for civil surgeon designation is submitted accurately.