Fees for Uninsured/Third Party Services

Uninsured Services and all Third Party requested forms are not covered by the Provincial Health Insurance Plan and will be charged to the patient. These rates are outlined by the Ontario Medical Association and are charged accordingly.

PLEASE ASK FOR INFORMATION REGARDING OUR BLOCK FEE PAYMENTS IN LIEU OF INDIVIDUAL CHARGES.

Please Note: Fees associated with PROCEDURES such as other immunizations not listed below, skin tags and or mole removals, etc. will be based on assessment.

We accept for your convenience cash, debit, cheque, VISA and MASTERCARD.

A $25.00 fee applies to all NSF cheques.

TELEPHONE PRESCRIPTION RENEWALS REQUIRE 48 HOURS TO BE COMPLETED. PLEASE ENSURE YOU HAVE ENOUGH MEDICATION OR GET YOUR PRESCRIPTION AT YOUR OFFICE VISIT.

MISSED APPOINTMENTS
Missed or Cancelled Appointments (minimum of) $30.00
TELEPHONE/CHART TRANSFERS/PHOTOCOPYING
Chart summary/transfer of medical records (pages 1 through 5) $29.00
(Thereafter per page) $1.00
Retrieval of off site records $50.00
Photocopying & Faxing (per page) $1.00
Telephone Prescription Renewal $ 25.00
Telephone Advice/Interview-during office hours $ 20.00
Telephone Advice/Interview-after hours $ 30.00
FORMS & ASSESSMENTS
Driver’s Medical Examination (Physical + 1 Form) $130.00
(Additional Forms for Completion) $  30.00
Insurance Medical Examination (Physical + 1 Form) $145.00
Pre-employment or Employment Physical $100.00
FORMS ONLY
Back to Work/Sick Note/Daycare $  15.00
Disability Tax Credit (Revenue Canada, Federal) $  43.20
Fitness Certification $  25.00
Legal Letters, in-office telephone meetings Variable
Maternity UIC $  17.00
Motor Vehicle Accident Form 4 $  58.00
Pilot’s Civil Aviation: Form 26-0010 (0890- form + physical) $ 150.00
Private insurance, sickness, disability $  22.00
School and Camp $  10.00
Travel Advice Variable
Travel Cancellation Insurance Form $  25.00
Unemployment Insurance $  15.00
Documentation of TB test $  15.00
PROCEDURES
Wart Treatments $  15.00
Injection of Travel related vaccination (per vaccination) $  15.00
TB skin test (administration only) $  15.00