Uninsured Services



    PAY-PER-SERVICE PRICE VALUE PLAN NOTES
    Prescription Renewals
    Prescription Renewals 3 $15
    Prescriptions, Massage, Physio, Chiropody, Chiropractor, etc.
    Forms 2
    Sick Note $20
    Back to work / Daycare / Freedom from communicable Disease
    Short Form $30
    School / University / Camp / Daycare / Volunteer / Jury Duty / Gym Certificate
    Extended Form $60
    CRA Disability Tax Credit / Trip Cancellation / Fitness Club Form / CAS Foster Parent
    Long Form $125
    Insurance: Life, Private, Immigration, Private, Disability
    Auto Accident Benefits $135
    OCF 3, 18, 19, 23
    Attending Physician Statement $150
    Driver's Physical $150
    Pension Buy Back $150
    Administrative Costs
    Test Result Copy (per result) $5
    Copy of Immunization form $5
    Missed Regular Appointment $50
    X
    Missed Physical Appointment $75
    X
    Chart Transfer – Summary $50
    Chart Transfer – Full $100
    X
    Procedures
    Liquid Nitrogen – Initial Lesion $30
    $10/Lesion for each additional. Value Plan limited to 15 lesions/year.
    Travel Injection $10
    TB Mantoux Test $45
    Dressings $25
    Glue for lacerations $20
    Shave Excision $100
    X
    Full Excision $170
    X
    Face/Neck Excision $200
    X
    Consultations
    Intermediate Assessment $75
    X
    General Assessment $165
    X
    Travel Medicine 1 $75
    X

    Notes

    1 Contact clinic to determine if your family physician provides travel medicine services
    2 Forms do not include medical assessment
    3 Prescription renewals are subject to medical assessment