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Fees & Services: Fee List
(Updated July 2024)​
Every effort has been made to account for most of the commonly requested services in the enclosed fee list. If the uninsured service you require is not listed, or you need clarification on a fee, please call the office for clarification.
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Disclaimer: This fee list is subject to change and may not be up-to-date. The fees below are in accordance with the Ontario Medical Association’s Physician’s Guide to Uninsured Services (January 2024 edition).
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​​​​​​​​​​Uninsured Service
Notes, Forms, and Certificates
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Private Insurance Notes for Coverage - Massage, Orthotics, Chiro, Acupuncture, Compression Stockings, Braces, Other Devices
Return to Work Note, Sick Note, Daycare Note
Disability Tax Credit Application
Completion of Documentation Forms for School Physicals, Camps, Daycare, Education, incl. OSAP and Vaccine Form​
Travel Insurance Cancellation Form
Certificate of Fitness Form for Pre-Employment (hospital/nursing home employee)
Retirement Home Admission Forms
Guarantor Documents (i.e. birth certificates)
EI Disability
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Other Specific Forms & Assessments
MOT Driver’s Physical + Urine + Form Completion***
Pre-Adoption Exam and Evaluation (Children’s Aid Application for Prospective Foster Parent)
MOT Diabetic Form
OCF-3/OCF-18 Disability Certificate
Attending Physician Statements/Employment Related
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Other General Uninsured or Third-Party Forms (if not listed above)
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CPP Medical Report
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Diagnosis, Counseling, and Treatment
Prescription Renewal Without an In-Office Visit
Administration of Vaccinations for Immunizations (if not covered under OHIP)
Employment TB Injection + Nursing Assessment (if not covered under OHIP)*
Non-OHIP Covered Pap Test
Non-OHIP Ear Syringing
Liquid Nitrogen (if not covered under OHIP)
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Other Services
Missed or Cancellation of Routine Appointment (without 24 hours notice by phone)
Missed or Cancellation of Mental Health or Well-Baby Visit (without 24 hours notice by phone)
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Missed or Cancellation of Procedure Including Cosmetic Procedures (without 24 hours notice by phone)
Replacement of Immunization Certificate
Copy of Medical Report (print/mail/email/fax)**
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Physician Review of Records for Transfer if >15 mins required
Transfer of Medical Records by Electronic Fax to Accepting MD, or Patient Pick-Up USB or CD (one transfer per insured patient)
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* Cost of TB vaccine and form completion are additional costs
** Requires physician review of the medical record to be released per IPC (Information Privacy Commissioner) guidelines, clerical labour costs, equipment lease, secure electronic storage/programming costs via OCEAN platform, secure record storage space, etc.
*** Suggested Ontario Medical Association rate is $313.00: $235.85 (physical) + $7.15 (urine) + $70 (form completion)
X: No discount available..​​​​​​​​​​​​​​​​​​​
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