non-INSURED FEES
Clinic Policy 2021
Non-Insured Services and Procedures
You will be billed for some services and procedures that are not covered by the Ontario Health Insurance Plan. A list of the non-insured services and corresponding fees may be found below.
Fees for Non-Insured Services and Procedures
These fees are subject to change without notice. Physicians reserve the right not to charge for certain items based on individual circumstances.
Currently, we are limited to accepting payments by cash or cheque.
Visits and Procedures
SERVICE
​
Complete Exam
​
Intermediate Exam
​
Minor Exam
​
TB (injection + interpretation)
​
TB (2step)
​
TB (injection only)
​
Immunization (injection only)
​
Cortisone (infusion)
​
Liquid Nitrogen (one application)
​
Liquid Nitrogen (multiple applications)
​
Other Exams
FEE
​
$176.78
​
$77.20
​
​
$50.00
​
$35.00
​
​
$50.00
​
$25.00
​
$15.00
​
​
$25.00
​
​
$30.00
​
​
$45.00
​
​
​
Variable
Office Procedures
SERVICE
​
Not Requiring Sutures
​
1 to 3 Lesions
​
Cyst, Lipoma, Biopsy Excision with Sutures
​
​
FEE
​
$35
​
​
$45
​
​
$75
Missed Appointments
SERVICE
​
Complete
(30 minutes)
​
Follow-up
(15 minutes)
​
​
FEE
​
$40
​
​
​
$20
Chart Transfers
SERVICE
​
Chart Transfer (Individual) Review
​
Chart Transfer (Family) Review
​
​
FEE
​
$40
​
​
​
$60
Administrative Fees
SERVICE
​
Paper copies 1 to 20 pages
​
Paper copies 21+ pages
​
Disk fee
​
Postage/Courier
​
Retrieval from Archive
FEE
​
$30
​
​
$0.25 per additional page
​
$40
​
Variable
​
Variable
Other Services
SERVICE
​
Prescription Renewal (by fax or telephone)
​
Lost Requisition
​
​
FEE
​
$20
(no charge if patient is 80+)
​
$10
Third Party Forms
SERVICE
​
School /
Summer Camp
​
Admission (daycare/school/ graduate studies)
​
Wellness Certificate (fitness to work)
​
Employees (hospital/nursing home)
​
Daycare (disease-free)
​
Maternity Certificate
​
Employer Forms (other)
FEE
​
$30
​
​
​
$30
​
​
$40.25
​
​
​
$40.25
​
​
​
$21
​
​
$20
​
​
$35
​
* examination fees not included
Third Party Visits
SERVICE
​
Driver's licence (includes complete exam, urinalysis and form)
​
Attending Physician's Statement
​
Insurance Certificate OCF-18
​
Insurance Certificate OCF-3
​
Insurance Certificate OCF-23
​
Insurance Certificate OCF-19
​
System or Disease Specific Questionnaire
​
Medical Evaluation for Insurance Purposes (includes complete exam)
​
Trip Cancellation
​
Death Certificate (for life insurance)
​
Compassionate
Care Certificate
FEE
​
$150
​
​
​
​
​
$153
​
​
​
$153
​
​
$153
​
​
​
$152
​
​
$126
​
​
$102
​
​
​
​
$249
​
​
​
​
$41
​
$51
​
​
$59
Government Forms
SERVICE
​
Federal Disability Tax Credit
​
CPP Disability Medical Report (up to $85 paid by government)
​
CPP Narrative Report (up to $150 paid by government)
​
CPP Request for Reassessment
​
Citizen and Immigration
Request for Medical Information (Application to Armed Forces)
​
Central Collection Service (Request for Physician's Information)
FEE
​
$79
​
​
​
$125
​
​
$150
​
​
​
$25
​
​
​
$125
​
​
$100
​
​
$125
​
Other Services
SERVICE
​
Application for Foster Parents / Adoption (CAS)
​
Medical Certificate for Employment Insurance Sickness Benefits (INS5140)
​
FEE
​
$62
​
​
​
​
$42
Sick Notes
SERVICE
​
With Appointment
Without Appointment
​
​
FEE
​
$21
​
​
$27
Hourly Rate
SERVICE
​
Our Physician Hourly Rate
​
​
FEE
​
$175 to $250