Non OHIP Services
Forms: (exam extra)
Sick notes 20
Back to work notes 20
Day care notes. 20
Massage, chiropractor, orthotics, 25
physiotherapy notes 25
Work/camp/school forms 25
CAS application foster parents form 55
Forms for university/education institution 40
Pre-employment certificate of fitness form 40
Health status for hospital/nursing home 40
Jury duty letter 30
Lost notes/prescriptions 15
Immunization summary form 20
Travel Cancellation form 45
Lawyer's letter /forms (billed OMA rates/hour)
Insurance Forms:
OCF-18 treatment plan( billed to insurance) 140
OCF-3 disability certificate 140
Travel cancellation form 30
Life insurance /Death certificate 40
Attending physician's statement. 130
Insurance Medical Questionnaire 75
Disability forms short term 50
Disability Long term form. 100
Government Forms:
CPP disability medical form (billed to govt). 85
Revenue Canada Federal Disability Tax Credit. 45
EI disability /maternity certificate 25
EI compassion care certificate 40
EXAMS
Non-OHIP full examination 80-120
Drivers Medical exam (and form) 120-150
Physical exam required by third party (exam only) 120
School camp exam only 70
***. all values in Canadian Dollars $$
**PLEASE NOTE RATES MAY CHANGE
AT DOCTORS DISCRETION**
APPOINTMENTS***
WE REQUIRE 24 HOURS NOTICE FOR CANCELLATION OF ANY APPOINTMENTS
Missed regular appointment 40
Missed physical exam 80
Missed counselling/
psychotherapy 20-30 min. session. 70
Telephone advice 20
Staff to give results on phone. 20
Procedures:
TB Skin Mantoux Test
1 step 20
2 step 40
form extra 50
Wart Cryotherapy
(not plantar or genital)
First 25
Each additional wart 10
Max $75
Skin Tag removal
50 - 200
Medical Supplies at cost plus 50% overhead
Transfer of Medical Records
First 5 pages. 45
each subsequent page TBD
Photocopying charts (patient requested)
First page 5
Subsequent pages 1
Immunizations summary form 20
TRAVEL ADVICE
Travel advice in the office 50
Travel vaccines (per injection) 20
*** debit , credit , cheques NOT accepted
