Register your practice

Tell us about your practice and the civil surgeon on staff. We'll review and email your primary contact a sign-in link once approved.

Part 7 Line 1 — Civil Surgeon's Information

Family Name (Last Name) *

Given Name (First Name) *

Middle Name (if applicable)

Civil Surgeon Identification Number (CSID)

Practice Name *

Street Number and Name *

Apt., Ste., or Flr.

Number

City or Town *

State *

ZIP Code *

Same as physical address

Daytime Telephone Number *

Mobile Telephone Number (if any)

Email Address *

This will also be used as the practice administrator login. Once approved, we'll email this address to set up the account.

By submitting, you confirm the civil surgeon named above is currently designated by USCIS. We review every application before approval.