| Form / Service |
|
Fee |
| Attending Physician's Statement |
- insurance companies
- w/ narrative of chart |
$84.00
$100.00 |
| Auto Sales Tax Rebate Form |
|
$23.75 |
| Back to Work/School Note/ Form |
|
$10.00 |
| Charitable Institution Form (i.e.
United Way) |
|
N/C |
| Chickenpox Vaccine (VARIVAX) |
|
$80.00 |
| Children's Aid Society (when child
is in custody of CAS) |
OHIP rates |
| CPP Disability Medical Report (excess
of $65.00 is pt's responsibility) |
$65.00 |
| CPP Disability Person Form (minimum) |
|
$30.00 |
| Disability Certificate #OCF -3/59 |
|
$84.00 |
| Doctor's Visit (No OHIP) |
- Mon to Fri
- Sat, Sun, Holiday |
$50.00
$70.00 |
| Ear Piercing |
|
$20.00 |
| Employer-Specific Return to Work
(i.e. Canada Post) |
$20.00 |
| Handicapped Parking Sticker |
|
N/C |
| Home Care Application/CCAC Form |
|
N/C |
| Immigration Medical (fee varies) |
|
See info |
| Independent Medical Examination Insurance
Company (IME) |
$160.00 |
| Insurance Company Treatment Plan
#OCF -18/59 |
|
$84.00 |
| Insurance Disability Form (Off-Sick
Form) |
|
$15.00 |
| Life Insurance Death Certificate |
|
$30.00 |
| Limited Use (LU) Drug Form |
|
N/C |
| Maternity UIC Form (INS 2019) |
|
$17.75 |
| Medical (for third party) |
|
$84.00 |
| Medical/Legal Report (per page) |
|
$100.00 |
| MOH Prior Approval |
|
N/C |
| MOT Driver's Medical |
|
$100.00 |
| Newborn Circumcision |
|
$160.00 |
| Passport Application Form (must know
doctor for at least 2 years) |
N/C |
| Photocopies (for duplicates or lost
originals) |
- 1 to 10 pages
- 11 to 20 pages
- 21 to 30 pages
- 31 pages or more |
$5.00
$10.00
$15.00
$20.00 |
| Photocopy Certification (per page) |
|
$5.00 |
| Pilot's Medical |
|
$100.00 |
| Pilot's Medical (with ECG) |
|
$135.00 |
| Pre-Employment Medical |
|
$86.00 |
| RCMP Visit |
|
OHIP rates |
| Pregnancy Test |
|
$5.00 |
| School, Daycare and Camp Forms |
|
$25.00 |
>
| TB Test(injection fee & form) |
|
$15.00 |
| Transfer of Medical Records |
- individual (fee may vary)
- family (fee may vary) |
$25.00
$50.00 |
| Travel Cancellation Form |
|
$25.00 |
| Travel Immunization (for each injection)
(extra fee for serum) |
$5.00 |
| Travel Visit |
- individual (per person)
- family (travelling together) |
$30.00
$60.00 |
| Wart Treatment |
|
$25.00 |
