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