Introduction
If you are applying for Canadian permanent residence through Express Entry in 2026, there is one rule you cannot afford to overlook: you must complete an immigration medical exam before you submit your application — not after.
This changed on August 21, 2025, when IRCC officially reinstated the upfront medical exam requirement for all Express Entry permanent residence applicants. Applications submitted without proof of a completed exam are returned as incomplete — with no grace period and no exceptions, unless you qualify for a specific exemption.
This guide explains exactly what the rule means, who it applies to, how to meet it within the 60-day window after your Invitation to Apply, and what documents you need to upload when you submit.
For a broader overview of the immigration medical exam process, see our complete guide to the Canadian immigration medical exam.
What changed and why
Before October 1, 2023, Express Entry applicants were required to complete their medical exam upfront before submitting a permanent residence application. Between October 2023 and August 2025, IRCC temporarily removed that requirement — applicants could submit first and complete the medical exam later, after receiving IRCC’s instructions.
As of August 21, 2025, IRCC reversed course. The upfront IME requirement is now reinstated and fully enforced. Applications received without proof of a completed IME are rejected for incompleteness, typically within 24 to 48 hours of submission. There is no opportunity to add the medical after the fact.
IRCC’s stated reason for the change is efficiency: having medical results on file at the time of application allows IRCC to process files faster and reduce overall wait times. For applicants, this means the medical exam is no longer something to deal with mid-process — it is a prerequisite.
Who the rule applies to
The upfront IME requirement applies to all principal applicants submitting a new Express Entry permanent residence application on or after August 21, 2025, across all three Express Entry streams:
- Federal Skilled Worker Program (FSWP)
- Canadian Experience Class (CEC)
- Federal Skilled Trades Program (FSTP)
It also applies to candidates nominated through a Provincial Nominee Program (PNP) who submit their permanent residence application through Express Entry.
Critically, the requirement extends beyond the principal applicant. All immediate family members must also complete the exam, including:
- Spouse or common-law partner
- Dependent children
- Dependent children of dependent children
This applies even to family members who are not accompanying the principal applicant to Canada. Non-accompanying dependants who are named in the application must still complete the IME upfront.
Applications submitted before August 21, 2025 are not affected and continue under the old process.
Who is exempt
You may be exempt from completing a new upfront IME if you meet all three of the following conditions:
- You already live in Canada
- You completed an immigration medical exam within the last five years
- Your previous IME results indicated low risk or no risk to Canadian public health and public safety
All three conditions must be met. If any one of them does not apply to you — for example, if you live outside Canada, or your previous IME is more than five years old — you must complete a new exam. There are no partial exemptions.
If you believe you qualify, IRCC makes the final determination. Even if you meet all three criteria on paper, IRCC may decide your previous results are not sufficient for your current application type and will send you instructions to complete a new exam. Given the 60-day application window, be prepared to book an appointment quickly if this happens.
What proof you need to submit
After completing your IME, your panel physician will give you one of two documents:
- Information Printout Sheet — a one-page summary with your photo and case number
- IMM 1017B Upfront Medical Report form — the official IRCC form confirming exam completion
You must upload one of these documents when submitting your permanent residence application through the Express Entry Profile Builder online. Without it, your application will be flagged as incomplete.
If you are claiming an exemption based on a previous IME, you must provide one of the following instead:
- Your Information Printout Sheet from the previous exam
- Your IMM 1017B form from the previous exam
- Your IME number (also called your unique medical identifier)
Upload whichever document you have. IRCC will use it to locate your previous results and assess whether they can be applied to your current application.
The 60-day window: how to time your exam
When you receive an Invitation to Apply (ITA) through Express Entry, you have exactly 60 calendar days to submit a complete permanent residence application. This deadline is strictly enforced — there are no extensions.
Within those 60 days, you need to complete your medical exam, receive your proof documents from the panel physician, and upload everything with your application. Panel physicians typically submit results to IRCC within 5 to 10 business days, but you do not need to wait for IRCC to receive and process the results before you submit — you just need the proof document from your physician.
The recommended timeline after receiving your ITA:
- Days 1–3: Book your medical exam immediately. Do not wait. Clinics in major cities book up fast, especially during peak periods.
- Days 7–14: Complete your exam. Allow 2 to 4 hours at the clinic for the full appointment.
- Days 14–15: Receive your Information Printout Sheet or IMM 1017B from the physician.
- Days 15–55: Complete the rest of your application documents and submit with the medical proof included.
- Day 60: Hard deadline. No extensions.
Do not book your exam before you receive your ITA. IME results are valid for 12 months — if you complete the exam speculatively before receiving an invitation and then experience delays in the draw cycle, your results may expire before you can submit. IRCC explicitly advises candidates to wait until after receiving an ITA before booking.
Step-by-step: completing the upfront IME
Step 1 — Find an approved panel physician
Only IRCC-approved panel physicians can perform your immigration medical exam. Your family doctor cannot do it. Use the IRCC Doctors directory to find a panel physician near you — search by city or country, view languages spoken, and access contact details and pricing.
Contact the clinic to confirm they are currently active, accepting new patients, and have availability within your 60-day window.
Step 2 — Book for yourself and all family members
Everyone named in your application needs an exam — your spouse or partner, your dependent children, and any non-accompanying dependants. Book appointments for everyone at the same time if possible, or staggered across the first two weeks of your window. Do not leave any family member’s exam until the last minute.
Step 3 — Prepare your documents
Read our immigration medical exam preparation guide for a full checklist. At minimum, bring:
- Original valid passport for each person being examined
- Glasses or contact lenses if worn
- A list of all current medications
- Any existing medical reports for pre-existing conditions
- Vaccination records if available (not mandatory but reviewed)
You do not need to fast before the appointment. Eat normally and drink plenty of water.
Step 4 — Complete the exam
The appointment covers identity verification, a medical history questionnaire, a physical examination, chest X-ray (age 11+), blood tests (age 15+), and a urine test (age 5+). Allow 2 to 4 hours per person. All components are done in a single visit at most clinics.
Be completely honest about your medical history. Concealing a condition that later appears in test results is treated as misrepresentation — far more damaging to your application than the underlying condition itself.
Step 5 — Collect your proof document
At the end of your appointment, you will receive either the Information Printout Sheet or the IMM 1017B form. Keep this document safe — it is your proof of completion and must be uploaded with your application.
Step 6 — Upload when submitting your application
When you submit your permanent residence application through the Express Entry Profile Builder, upload your proof document in the medical exam section. Ensure the scan is clear and legible. Submit before your 60-day deadline.
How much does it cost?
IRCC does not set a fixed fee. Each panel physician sets their own prices. As a general guide for Canadian clinics in 2026, a complete adult appointment including all required tests runs approximately CAD $250–$400. Children pay less as fewer tests are required at younger ages.
Costs outside Canada vary significantly by country and clinic. Use the IRCC Doctors directory to find clinics in your country — many list pricing directly on their profile.
The IME is not covered by any provincial health insurance plan. Refugees and asylum claimants may have costs covered through the Interim Federal Health Program (IFHP) — bring your Blue Cross documentation to your appointment.
What if my results show a medical issue?
The panel physician does not make decisions about your admissibility — IRCC does. The physician submits your results electronically and you move forward with your application.
If IRCC identifies a concern, one of two things will happen. They may issue a furtherance — a request for additional tests or specialist documentation — which is not a refusal and most applicants who receive one are ultimately approved. Or, in rare cases, IRCC may issue a finding of medical inadmissibility, meaning a condition poses a public health or safety risk, or would cost more than CAD $28,878 per year in health or social services. If this happens, you have the right to respond before a final decision is made. Seek advice from a licensed immigration lawyer or consultant immediately.
What if my IME expires before my application is decided?
IME results are valid for 12 months. If your application is still being processed after that window, IRCC will contact you with a re-medical request — instructions to complete a new exam. This is routine and does not indicate a problem with your file. Respond promptly, as delays in completing a re-medical can slow your application.
Frequently asked questions
Ready to find a panel physician?
Use the IRCC Doctors directory to find an IRCC-approved panel physician in your city or country. Each profile includes contact details, languages spoken, and pricing information to help you book quickly and confidently.
Last updated: May 2026. Always verify current Express Entry medical requirements at canada.ca before submitting your application.