On August 12, 2025, Immigration, Refugees and Citizenship Canada (IRCC) announced that applicants for permanent residence through Express Entry will be required to undergo an upfront medical examination as of August 21, 2025. Previously, applicants would submit their permanent residence application first, and only afterward receive instructions from IRCC to undergo the medical exam. With this change, submission of a medical exam at the time of the application becomes mandatory.

Note: This requirement applies at the stage of submitting the permanent residence application after receiving an ITA (Invitation to Apply), not at the stage of Express Entry profile registration.

• Applications submitted before August 21, 2025 are not affected.
• Permanent residence applications submitted outside of Express Entry are also excluded.

The principal applicant and accompanying family members must meet the criteria of medical admissibility to enter and reside in Canada.

Common reasons for refusal include cases where the applicant’s condition is determined to place an excessive demand on publicly funded health services. Specifically, if the projected annual healthcare cost exceeds CAD 27,162 (three times the average per capita healthcare cost in Canada, effective January 1, 2025), the application will be refused.

Applications may also be refused if the applicant has a condition that poses a risk to public health (such as certain communicable diseases) or if there is a risk of causing harm to others due to a mental health condition.

Applicants must undergo the medical examination at a clinic approved by IRCC, selecting a physician from IRCC’s panel physician list and contacting them directly to make an appointment.

All related costs must be borne by the applicant, including:

• Fees for the attending physician or radiologist
• Costs for specialized tests, procedures, or treatments
• Fees for specialist consultations

The medical exam may include:

• Review of medical history (surgeries, treatments, chronic illnesses)
• Full physical examination (including eyes, heart, lungs, etc.)
• X-rays (e.g., chest X-ray for tuberculosis screening)
• Blood and urine tests
• Mental health assessment
• Review of vaccination records

Applicants should bring the following:

• A list of current medications
• Medical records and test results regarding past illnesses or conditions
• Vaccination certificates
• Identity documents (such as a passport)

Applicants in Canada who have already undergone a medical exam for a work or study permit within the past five years may be exempt from retaking the exam. This exemption policy for certain visa and permanent residence applicants has been extended until 2029.

However, if IRCC determines that previous results cannot be used, applicants will be instructed to undergo a new medical exam.

With this policy change, applicants must now complete their medical exam before submitting their permanent residence application. Under Express Entry, applicants have 60 days after receiving an ITA to submit their application to IRCC. As the number of panel physicians is limited in some regions, making it difficult to secure an appointment, applicants are strongly encouraged to prepare and schedule their medical exams well in advance.