You no longer need to get an upfront medical examination before you submit your application for permanent residence through Express Entry.

On October 1, 2023, Immigration, Refugees and Citizenship Canada (IRCC) made changes to the Immigration Medical Exam (IME) requirement for Express Entry applicants. As per these new changes, Canada will no longer need Express Entry applicants and their family members to provide an upfront IME at the time of submitting their application.

Earlier, candidates and their family members were asked to attach proof of their upfront medical exam in their Profile Builder while submitting their application after receiving an invitation to apply (ITA), but this step is no longer required.

If you previously completed an IME as part of another application, then you can include it in your current application using the same upload slot.

‘OR’ If you have never completed an immigration medical exam (IME), you can upload a blank document in the same upload slot.

Furthermore, IRCC will send you instructions on when to complete your medical exam if they need it.

Source: Canada.ca