Thank you for your elaborate response and I agree with what you have mentioned. You can probably do upfront medical without ITA, if your clinic allows it.
However It is rather confusing the way they explained about the medical. So I did some thinking and went and looked at it again and again. Then finally found my answer from CIC itself.
I looked at the statement in quotes from the previous post of mine and then I went back to the link that you have shared(which is also below this)
http://www.cic.gc.ca/english/information/medical/medexams-perm.asp
I noticed that there are only two explanations for the medical exam
- Wait for instructions once you have submitted your application &
- Get your exam before you submit your application
Both of the above topics supports the earlier statement by the CIC.
Option 1, says once you receive an ITA(Not specifically mentioned however it is assumed in the context that this is trivial) get all the documents scanned and submit it with the PR application and then wait for the instructions from the CIC for the Medical Exam which is extremely time consuming. After you receive the instructions, you will have 30 days to take the medical exam.
Option 2, says once you receive an ITA get your Medical exam done (which is also known as Upfront medical exam) and doctors will give you a document and then submit a copy of that document with your application.
And since both of these require ITA, it would be safe to say that we should wait until we get the ITA and then go for Upfront medical. Just my opinion though!
Thank you once again!