The Canadian immigration medical exam: validity, cost and what happens
Almost every permanent residence file and many work, study and super visa files include an immigration medical exam (IME) with an IRCC panel physician. It is routine, it is not a fitness test, and the two things that go wrong are timing (an exam that expires before landing) and surprise (a finding nobody prepared for). This guide covers who needs the exam, how long it is valid, what it costs, what the doctor actually checks, how to time it for Express Entry and sponsorship, and what to do if IRCC raises a concern.
Key takeaways
The exam is routine and cannot be failed in the ordinary sense; IRCC's medical officers look only for public-health risks, public-safety risks and conditions likely to cost more than the excessive-demand threshold. The practical risks are an exam that expires before landing and a concern you did not prepare for. Time it against your program's processing time and bring your records.
- Validity: 12 months from the exam date; expiry before landing means a repeat exam.
- Who: every PR applicant and family member, accompanying or not; some temporary residents.
- Where: IRCC panel physicians only, results uploaded through eMedical; bring passport, glasses, medication list and reports.
- Cost: about $200 to $450 per adult in Canada, plus x-ray and lab where billed separately.
- Upfront or on request: depends on the program and, for Express Entry, on your ITA checklist.
- Concerns: answered through a procedural fairness letter, usually 90 days; see medical inadmissibility.
Who needs an immigration medical exam
| Applicant | Exam required? | Notes |
|---|---|---|
| Permanent residence, all programs | Yes, every applicant and every family member | Including a non-accompanying spouse and dependent children; a family member who refuses the exam makes the principal applicant inadmissible |
| Express Entry | Yes | Upfront or on request depending on the current instruction in your ITA |
| Spousal and family sponsorship | Yes | Usually requested during processing; the sponsor does not need one |
| Parents and Grandparents Program | Yes | Requested during processing |
| Super visa | Yes, upfront | Plus private medical insurance of at least $100,000 |
| Work or study permit, stay over 6 months | Yes if you lived 6+ months in a designated country in the past year | Designated countries are listed by IRCC (most of Africa, South and Southeast Asia, parts of Latin America and Eastern Europe) |
| Work in health, childcare, primary or secondary teaching, agriculture from designated countries | Yes regardless of country | IRCC's list of occupations requiring an exam |
| Visitor, stay under 6 months | No | Unless applying for a super visa |
| Citizenship | No | Citizenship has no medical requirement |
How long the medical exam is valid
Twelve months from the date of the examination. The rule is not that the application must be submitted within twelve months but that you must be admitted, landing as a permanent resident or having the permit issued, before the exam expires. Processing times that run past a year (parents and grandparents, inland spousal sponsorship at around 27 months, some provincial nomination files) routinely outlast the first exam, and IRCC then sends a request for a new one. That repeat exam costs the full fee again and adds four to eight weeks. The way to avoid it is to do the exam when the program actually asks for it rather than at the earliest possible moment, and, for Express Entry, to check the current instruction before booking.
Do not let the exam expire while you hold a COPR
Upfront exam or on request?
Some programs require the exam upfront, with the results submitted alongside the application: the super visa, most temporary resident applications where an exam applies, and Express Entry when the ITA checklist says so. Others request it during processing: family sponsorship, the Parents and Grandparents Program and most provincial nomination paper streams, where IRCC sends a medical request letter with an IME number and a deadline, usually 30 days. IRCC has changed the Express Entry instruction more than once, pausing upfront exams in October 2023 and revising the rule since, so treat the document checklist in your e-APR after your ITA as the authority. If you have not been asked and the program requests during processing, do not book early; you will be paying twice.
What happens at the exam
- 01
Find a panel physician
IRCC publishes the list by country and city. Only a panel physician can do the exam; your own doctor cannot. Book early in busy cities, where waits of two to four weeks are normal.
- 02
Bring the right things
Passport or travel document, your IME number or medical request letter if you have one, glasses or contact lenses, a list of current medications, and reports for any existing condition (a managed condition with a specialist letter is far easier for IRCC to assess than a bare diagnosis). Some clinics ask for photographs.
- 03
The examination
Medical history and medications; a physical (height, weight, vision, hearing, blood pressure, heart, lungs, abdomen, limbs, skin, a mental-state check); a chest x-ray for those 11 and over; blood tests for HIV and syphilis for those 15 and over; a urine test for those 5 and over. Further tests or a specialist referral follow only if a finding needs it.
- 04
Results go to IRCC, not to you
The physician uploads the file through eMedical, usually within a few days to two weeks, and gives you a receipt with the IME number. Keep it; it is your proof of an upfront exam and, for the in-Canada exemption, the number you enter next time.
- 05
IRCC assesses
The application tracker shows the medical as passed, in review or requested. Most files pass without comment. A concern produces a procedural fairness letter, not a refusal.
What the exam costs
| Item | Typical cost (CAD) | Notes |
|---|---|---|
| Adult exam in Canada | $200 to $450 | Panel physicians set their own fees; large cities at the upper end |
| Child exam in Canada | $140 to $200 | Fewer tests below 5, 11 and 15 |
| Chest x-ray and laboratory tests | $0 to $150 | Often included; sometimes billed by the lab or imaging clinic |
| Exam abroad | Varies widely | Under $100 in some countries; several hundred in others |
| Repeat exam after expiry | Full fee again | No discount; the reason to time the first one |
The in-Canada exemption for recent exams
Since October 2024, applicants inside Canada who completed an immigration medical exam within the previous five years and were assessed as low risk to public health or safety may not need a new exam for a further in-Canada application. The exemption is applied when you enter the earlier IME number in the application; IRCC checks the previous result and tells you if a new exam is needed after all. It has been extended more than once and is a public policy rather than a permanent rule, so confirm it is still in force when you apply. It does not apply to applicants outside Canada.
What the exam is looking for, and what happens if it finds something
The panel physician records; IRCC's medical officers decide, against section 38 of the Immigration and Refugee Protection Act. Three questions are asked. Is the applicant a danger to public health (active tuberculosis, untreated syphilis)? A danger to public safety (a rare finding, tied to specific behaviours)? Or would their condition place excessive demand on health or social services, meaning expected costs above a published per-year threshold over five years, currently in the region of $27,000 to $28,000 a year? Spouses, partners and dependent children being sponsored, and refugees, are exempt from the excessive-demand ground entirely. HIV is not a bar in itself; a managed condition rarely is.
If a concern is raised, IRCC sends a procedural fairness letter, usually with 90 days to respond for excessive demand, and the response is where files are won: specialist reports, evidence that a condition is stable, private insurance or a credible mitigation plan showing the cost will fall below the threshold, or an argument that the exemption applies. Our medical inadmissibility guide covers the threshold, the exemptions and the response in detail.
Timing the medical for the common programs
| Program | When to do the exam | Why |
|---|---|---|
| Express Entry | As your ITA checklist instructs; if upfront, within days of the ITA | About 6 months of processing after e-APR; an upfront exam done on time is valid at landing |
| Spousal sponsorship (outland, ~17 months) | When IRCC requests it, typically mid-process | An exam at submission would expire before the decision |
| Spousal sponsorship (inland, ~27 months) | When requested; expect a second exam if processing overruns | Twelve months rarely covers an inland file |
| Parents and grandparents | When requested | Long processing; do not pre-book |
| Super visa | Upfront, with the application | Required at submission with the insurance |
| Work permit needing an exam | Upfront, before applying | Processing is short; the exam is a submission document |
| Provincial nomination + federal PR | At the federal stage, when the checklist or a request says | The provincial stage does not need it |
How we help
Wild Mountain Immigration is a licensed RCIC practice (CICC R706497) in Canmore, Alberta. We time the medical against the real processing time for your program, tell you what to bring so a known condition is documented rather than discovered, and, if IRCC raises a concern, prepare the fairness letter response. The exam itself is between you and the panel physician; nothing on this page is medical advice.
Frequently asked questions
How long is an immigration medical exam valid for Canada?
Twelve months from the date of the examination, not from the date IRCC receives the results. You must be admitted to Canada (land as a permanent resident, or have your permit issued) before the twelve months run out; if the file is still in process when the exam expires, IRCC asks for a new one, which resets the clock and adds four to eight weeks.
How much does the immigration medical exam cost?
Panel physicians set their own fees. In Canada, expect roughly $200 to $450 for an adult and $140 to $200 for a child, plus the chest x-ray and laboratory tests where they are billed separately. Abroad, fees vary from under $100 to several hundred dollars. IRCC does not cover the cost and there is no discount for a repeat exam.
Who needs an immigration medical exam?
Every permanent residence applicant and every accompanying family member, whether or not they are coming to Canada, including a non-accompanying spouse and dependent children. Temporary residents need one if they will stay more than six months and have lived for six months or more in a designated country in the past year, if they will work in a health, childcare or similar occupation, or if they are applying for a Parent and Grandparent Super Visa.
What does the immigration medical exam include?
A review of your medical history and medications, a physical examination (height, weight, vision, hearing, blood pressure, heart, lungs, abdomen, limbs, skin, mental state), a chest x-ray for applicants aged 11 and over, a blood test for HIV for those 15 and over and syphilis for those 15 and over, and a urine test for those 5 and over. Some applicants are asked for further tests or a specialist report based on the findings. It is not a fitness test and you do not fail for being unwell; it looks for public-health risks and conditions that would place excessive demand on services.
Can I use my own doctor?
No. Only an IRCC-approved panel physician can perform the exam and upload it through the eMedical system. Your family doctor's records can help the panel physician, particularly for a managed chronic condition, but the exam itself must be done by a panel physician. IRCC publishes the list by country and city.
Should I do an upfront medical exam for Express Entry?
Follow the instruction in your ITA. IRCC has changed the Express Entry rule more than once: upfront exams were required, then paused in October 2023 in favour of a request during processing, and the instruction has been revised again since. Your invitation and the e-APR document checklist say which applies to you. If the checklist asks for proof of an upfront exam, book the panel physician the day you receive the ITA; if it says to wait for a request, do not spend the money early, because an exam done too soon can expire before landing.
What if I already had a medical exam recently?
Applicants in Canada who completed an immigration medical exam within the previous five years and were assessed as low risk may be exempt from a new exam under a temporary public policy IRCC introduced in October 2024; the exemption is applied automatically when you enter the previous exam's IME number in the application. Applicants outside Canada, and anyone whose previous exam was not low risk, need a new exam.
What happens if the medical exam finds a problem?
The panel physician does not decide anything; IRCC's medical officers assess the results. If a condition raises a public-health, public-safety or excessive-demand concern, IRCC sends a procedural fairness letter setting out the finding and giving you time to respond, usually 90 days for excessive demand. Many concerns are answered with specialist reports, evidence of a managed condition, or a mitigation plan. Our medical inadmissibility guide explains the threshold and the exemptions.
Not sure when to book the medical?
Tell a licensed RCIC which program you are in and we will tell you when the exam should happen so it is valid when you land.