If you do not send it in with the initial package, your application may be rejected. You should go see the doctor and include the sealed envelope you receive from him/her with your application.
[This answer is for general purposes only; it does not constitute advice and does not establish an attorney-client relationship.]
Must attach medical exam in a sealed envelope. Otherwise the application can be rejected. So, yes, you have to see the civil surgeon before your mail out the I-485.
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USCIS requires completed medical examination from a civil surgeon on form I 693 to be submitted with the adjustment of status application.
Disclaimer: Salvatore A. Falletta - 201 438-5625: This answer found here is general in nature. No attorney/client relationship is formed from this response.