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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

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Office Procedures

SERVICE

Not Requiring Sutures

1 to 3 Lesions

Cyst, Lipoma, Biopsy Excision with Sutures

FEE

$35

$45

$75

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Missed Appointments

SERVICE

Complete

(30 minutes)

Follow-up

(15 minutes)

FEE

$40

$20

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Chart Transfers

SERVICE

Chart Transfer (Individual) Review

Chart Transfer (Family)       Review

FEE

$40

$60

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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

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Other Services

SERVICE

Prescription Renewal (by fax or telephone)

Lost Requisition

FEE

$20

(no charge if patient is 80+)

$10

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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

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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

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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

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Other Services

SERVICE

Application for Foster Parents / Adoption (CAS)

Medical Certificate for Employment Insurance Sickness Benefits (INS5140)

FEE

 

$62

$42

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Sick Notes

SERVICE

With Appointment

 

Without Appointment

FEE

$21

$27

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Hourly Rate

SERVICE

Our Physician Hourly Rate

FEE

$175 to $250