Uninsured Services

2016-2017 Schedule of Fees for Uninsured Service

Simple Forms & Fee

  • Missed / Return to Work / School – $20.00
  • School / Camp – $25.00
  • Admission to Daycare / Preschool / College / University – $35.00
  • Pre-Employment Certification for Fitness/Fitness Clubs – $35.00
  • Hospital / Nursing Home Employees – $35.00
  • Federal Employee Absence Notes – $25.00
  • Certificate of Freedom from Communicable Disease – $20.00
  • Certificate of Disability (Insurance Company Form) – $40.00
  • Registered Massage Therapy Note (requested for insurance) – $20.00
  • Chiropractic Care Note (requested for insurance) – $20.00
  • Custom Made Orthotics / Orthopedic Footwear Note – $20.00
  • Simple forms not otherwise listed (per page) – $20.00

Licencing Forms & Fee

  • MTO Driver’s Licence Application / Renewal – $95.00
  • Application for Driver’s Assessment (reinstating of licence) – $50.00

Insurance Certificates & Fee

  • #OCF-18 Treatment Plan – $129.50
  • #OCF-3 Disability Certificate – $129.50
  • #OCF-8 Certificate of Health Practitioner – $106.25
  • #OCF-19 Determination of Catastrophic Impairment – $35.00
  • Travel Cancellation Insurance Form – $45.00
  • Life Insurance – Death Certificate – $45.00
  • Medical Certificate for Employment Insurance Compassionate Care Benefits – $50.00
  • Government Forms & Fee
  • Citizen and Immigration Canada medical report – $125.00
  • CPP Disability Medical Report Form – $129.50
  • Request for Medical Information for Canadian Armed Forces applicants – $100.00
  • Central Collection Service Request for Physician’s Information – $125.00
  • Revenue Canada Federal Disability Tax Credit – $45.00
  • Auto Sales Tax Rebate Form – $35.00

Life/Health Insurance Assessments and Reports & Fee

  • Attending Physician’s Statement (without medical exam) – $139.85
  • System – Specific or Diseases Specific Questionnaire without medical exam – $85.00

Office Procedures & Fee

For travel vaccine administration, please talk to Doctor or Nurse, and then book an appointment with reception. This is a separate office visit, there is a fee associated with this visit as this service is not covered by OHIP.

  • Skin Tag Removal (per 10) – $100.00

Non-cancerous moles:

  • Face – $100.00
  • Body (Initial mole) – $75.00
  • Body (Each additional lesion) – $50.00
  • Wart treatment with cryotherapy (per lesion, except for feet or genitals) – $10.00