Medical fees .pdf

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COUNTRY
CHAPTER

USA

The
UNITED STATES
OF AMERICA
BY THE GOVERNMENT OF
THE UNITED STATES OF AMERICA

KNIGHTSBRIDGE DOCTORS PRICING INFORMATION
Item

Description

Unit Price £

1

Basic Medical Examination – Adult (15 years of age and older)

250.00

2

Basic Medical Examination – Child (under 15 years of age)

120.00

3

Bacteriological examination of Sputum x3

115.00

4

DNA Collection Adult

100.00

DNA Collection Child

50.00

5

Non-Immigrant Visa

305.00

6

Drug & Alcohol Lab Test Fee (each)

50.00

7

Chain of Custody Drug Screen

80.00

Supplemental Charges for vaccination against:
8

Diphteria, tetanus and pertussis

45.00

9

Tetanus, diphtheria & polio

35.00

10

Measles, Mumps and Rubella

45.00

11

Hepatitis B

40.00

12

Hepatitis A and Hepatitis B Combined

40.00

13

Varicella

14

Pneumococcal - Adult

40.00

15

Pneumococcal - Child

75.00

16

Influenza

22.00

17

Meningococcal MCV

35.00

18

Rotavirus

67.00

19

Hepatitis A

40.00

20

Hepatitis B Child

40.00

21

DTaP + Hib

45.00

Syphillis Treatment (if available) or Private Prescription Cost for Treatment
Drug Screen
Immunity Screen for Measles
Immunity Screen for Mumps
Immunity Screen for Rubella

IV018a Medical Questionaire Updated May 2015. Page 6

Not available

50.00
65.00
65.00
65.00

Vaccination Requirements
Age
Vaccine

DTP/DTaP/DT

Birth - 1

2 - 11

month

months

12 months to 4 years

5 - 6 years

7-

18 -

17

64

years years

No

Yes

≥ 65
years

No
Yes, ≥ 7 years old

Td/Tdap

(for Td); 10-64

No

years old (for
Tdap)

Polio: IPV or
OPV

No

MMR

Yes
No

No

Yes if born in 1957 or later

No

Varicella
(Chickenpox)

No

Not available

Yes

in the UK
Pneumococcal

No

Yes, through 59 months of age
(for PCV)

Birth 11
months

Hepatitis A

No

12 - 23

24 months to ≥ 65

months

years

Yes

No
Age

Vaccine
Hepatitis B

≥ 18

Birth - 18 years

years

Yes, through 18 years of age

No
Age

Vaccine
Hib

Birth - 1

2 - 59

month

months

No

Yes

≥ 60 months
No
Age

Vaccine

Birth - 5

6- 59

60 months to

months

months

49 years

7
IV018a Medical Questionaire Updated May 2015. Page 7

No

(for
PPV)

Age
Vaccine

Yes

≥ 50 years

Yes
Influenza

No

Yes

No

Annually each flu
season
Age

Vaccine
Meningococcal
(MCV/MPSV)

Birth - 10

11 - 18

years

years

No

Yes

19 years to ≥ 65 years
No
Age

Vaccine

Birth 1
month

Rotavirus

No

12
2-6
months

months 5 - 6
to 4

years

years

7-

18 -

17

64

≥ 65 years

years years

Yes

No

DTP=diptheria and tetanus toxoids and pertussus vaccine;
DTAP=diphtheria and tetanus toxoids and acellular pertussis vaccine;
DT=pediatric formulation diphtheria and tetanus toxoids;
Td=adult formulation tetanus and diphtheria toxoids;
IPV=inactivated polio vaccine (killed);
OPV=oral polio vaccine (live);
MMR=combined measles, mumps, rubella vaccine;
Hib=Haemophilus influenzae type b conjugate vaccine;
PCV=pneumococcal conjugate vaccine;
PPV=pneumococcal polysaccharide vaccine.

8
IV018a Medical Questionaire Updated May 2015. Page 8

U.S. MEDICAL QUESTIONNAIRE
(MUST be completed and signed by applicant prior to medical appointment)
CASE NUMBER:

VISA CATEGORY:

NAME:

(First)

(Last)

DATE OF BIRTH:
BIRTHPLACE: (City/Country)
PRESENT COUNTRY OF RESIDENCE:
PRIOR COUNTRY:
NATIONALITY:
CURRENT ADDRESS:
TEL:
INTENDED U.S. ADDRESS:

(Middle)

AGE:

GENDER: male

OCCUPATION:

EMAIL ADDRESS:

HEIGHT (in centimetres):

WEIGHT (in kilos):

1

Have you ever been hospitalized (including psychiatric admission)?

2

Have you been investigated or treated for any major illnesses?

3

Have you ever had any kidney or liver disease?

4

Have you ever had any mental disorder or depression?

5

Have you ever used drugs?

6

Have you ever had an addiction to or abused alcohol?

7

Have you had any form of treatment or investigations for alcohol
or drug abuse?
Have you ever caused deliberate injury to yourself or others?

8
9
10
11

female

YES

NO

Have you ever been arrested, convicted or received a warning for
any drug or alcohol offense (including driving)?
Do you take any medication? (Please list all medications on a
separate sheet)
Are you pregnant?
If the answer is yes, please provide evidence of pregnancy/copy of pregnancy test result.

Date of last period:
DATE:+

Expected delivery date:
SIGNATURE:

IV018a Medical Questionaire Updated May 2015. Page 9