Medical Exemptions · Citizenship Test Waiver
N-648 disability waiver · St. Louis
Form N-648 Disability Waiver Evaluation
Some applicants for U.S. citizenship have a medical condition that lasts 12 months or more. Because of it, they cannot learn English or U.S. civics. Examples are dementia, stroke, developmental disability, or severe psychiatric illness. Form N-648 lets a licensed physician certify that condition. Then the applicant may be excused from the English and civics tests.
Schedule your N-648 evaluation Text (314) 886-5902 to begin
Evaluations performed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, USCIS-designated civil surgeon (CSID 111051) and MoCA-certified rater · Service launch announced on major newswires, July 2026
How does the N-648 evaluation work, and what does it cost?
Records review & case acceptance — $400
Non-refundable. Before scheduling, we screen your case and review your medical records (neurology, psychiatry, primary care, imaging, testing). We only accept cases with genuine medical merit — if your case does not qualify, we tell you honestly and decline it. If accepted, the full $400 is credited toward your evaluation fee.
Evaluation & certification — from $1,400
The in-person visit at our St. Louis office: a standardized cognitive assessment administered in your own language through an interpreter, completion of Form N-648, and a plain-language medical summary on office letterhead. The fee varies with the extent of analysis and document review your case requires; the $400 is credited, so accepted patients pay the balance.
Dr. Padda is a MoCA Certified Rater and USCIS-designated civil surgeon (CSID 111051) — cognitive testing uses validated instruments appropriate for patients with limited formal education, administered in your own language.USCIS-requested revisions — $190
For patients we evaluated within the past 12 months. Cases beyond 12 months, or originally evaluated elsewhere, require a full re-evaluation. Interpreter fees are paid directly by the applicant.
What testing is done for an N-648, and what do I receive?
Psychometric testing
Your cognitive function is measured with standardized, validated instruments appropriate for patients with limited formal education: the Montreal Cognitive Assessment (MoCA), the VA Saint Louis University Mental Status (SLUMS) examination and, in some cases, Cognivue computerized cognitive testing. Testing is administered in your own language through an interpreter. The scored results are documented in your Form N-648 and in your medical summary.
What you receive
- Your completed Form N-648, signed by the physician, as a PDF. This form is the Medical Certification for Disability Exceptions (current USCIS edition).
- A medical summary in plain words, on office letterhead.
See the official blank form: USCIS Form N-648 (PDF).
Schedule your N-648 evaluation
A $100 non-refundable scheduling fee reserves your appointment and is credited toward your N-648 fees.
Already booked? Complete the N-648 patient information form →
Dr. Padda explains the N-648, on camera
Hear the physician who owns the practice break down the federal criteria. He also covers the mistakes that sink most waivers.
Frequently asked questions
Can any doctor fill out Form N-648?
Form N-648 must be certified by a licensed physician who has evaluated the applicant. At our St. Louis office, Dr. Gurpreet Singh Padda, MD, MBA, MHP does the evaluation himself. He is a USCIS-designated civil surgeon (CSID 111051). He is also a MoCA-certified rater. He reviews your records. He gives a standardized cognitive assessment in your own language through an interpreter. Then he completes Form N-648 with a plain-language medical summary on office letterhead.
What kind of disabilities qualify for the citizenship test waiver?
The condition must prevent you from learning English or U.S. civics. It must last 12 months or more. Examples are dementia, stroke, developmental disability, or severe psychiatric illness. Take memory and thinking problems. Here, only severe memory loss or severe cognitive impairment meets medical necessity. Mild or moderate impairment does not qualify. Only USCIS decides whether an N-648 is sufficient. No physician can guarantee approval.
Where can I find an N-648 doctor near me in St. Louis?
Dr. Padda performs N-648 evaluations in person at our St. Louis office. Start with the $400 records review. There we tell you honestly whether your case has medical merit. If accepted, the full $400 is credited toward the evaluation. Schedule your N-648 evaluation online or text (314) 886-5902. Bring your existing medical records. That is because cases without supporting records generally cannot be accepted.
Think your case qualifies?
Text us to begin the records review. We’ll tell you honestly whether your case has medical merit.
Schedule your N-648 evaluation Text (314) 886-5902 Call (314) 960-9100
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP — USCIS-designated civil surgeon (CSID 111051), board certified in Anesthesiology, Pain Medicine, Interventional Pain Management, Addiction Medicine, and Obesity Medicine. Last reviewed September 2026.