Uninsured Services
| PAY-PER-SERVICE | PRICE | NOTES |
|---|---|---|
| Prescription Renewals | ||
| Prescription Renewals 3 | $20 | Prescriptions, Massage, Physio, Chiropody, Chiropractor, etc. |
| Forms 2 | ||
| Sick Note | $25 | Back to work / Daycare / Freedom from communicable Disease |
| Short Form | $35 | School / University / Camp / Daycare / Volunteer / Jury Duty / Gym Certificate |
| Extended Form | $80 | CRA Disability Tax Credit / Trip Cancellation / Fitness Club Form / CAS Foster Parent |
| Long Form | $200 | Insurance: Life, Private, Immigration, Private, Disability, Attending Physician's Statement |
| Auto Accident Benefits | $160 | OCF 3, 18, 19, 23 |
| Driver's Physical | $200 | |
| Pension Buy Back | $250 | |
| Other Complex Forms | Physician's Hourly Rate | |
| Administrative Costs | ||
| Test Result Copy (per result) | $5 | |
| Copy of Immunization form | $5 | |
| Missed Regular Appointment | $50 | |
| Missed Physical Appointment | $75 | |
| Chart Transfer – Summary | $50 | |
| Chart Transfer – Full | $100 | |
| Procedures | ||
| Ear irrigation (if not deemed medically necessary) | $25 | |
| Pregnancy Test (if not deemed medically necessary) | $10 | |
| Liquid Nitrogen – Initial Lesion | $50; 2-3 lesions $100; 3-4 lesions $150 | |
| Travel Injection | $20 | |
| TB Mantoux Test | $50 – one step; $100 – two step | |
| Dressings | $25 | |
| Glue for lacerations | $20 | |
| Shave Excision | $200 | |
| Full Excision | $300 | |
| Face/Neck Excision | $200 | |
| Consultations | ||
| Intermediate Assessment | $90 | |
| General Assessment | $200 | |
| Travel Medicine Consultation 1 | $90; each additional person $45 |
Notes
1 Contact clinic to determine if your family physician provides travel medicine services
2 Forms do not include medical assessment
3 Prescription renewals may be subject to medical assessment