|
Prescription Renewals by Phone or Fax1 |
$40 |
|
Massage Referral |
$40 |
|
Chiropractic Referral |
$40 |
| Common Services |
Orthotics Prescription |
$40 |
|
Specialist Referral (without visit) |
$40 |
|
Acupuncture Referral |
$40 |
|
TB Skin Testing for Work / School (per step) |
$55 |
|
Surcharge to Securely e-mail Forms / Notes / Referrals to Patient (PHIPA-compliant) |
$15 |
|
Sick Notes / Back to Work / Day Care Notes |
$40 |
|
School / Camp Forms |
$40 |
|
Fitness Club Forms |
$40 |
|
Pre-employment Certificate of Fitness |
$50 |
|
Driver's Medical Examination and Form |
$185 |
|
Citizenship and Immigration Report |
$75 |
|
Travel Cancellation Letter |
$50 |
| Notes and Forms |
Revenue Canada Federal Disability Tax Credit |
$100 |
|
CPP Disability Medical Report Form |
$100 |
|
Private Insurance Sickness and Disability Note (short term) |
$75 |
|
Private Insurance Sickness and Disability Note (long term) |
$100 |
|
EIC Disability / Maternity Certificate INS2019 |
$75 |
|
Other forms not covered by OHIP or Third Party Insurance |
$40 - $150 |
|
Surcharge to Securely e-mail Forms / Notes / Referrals to Patient (PHIPA-compliant) |
$15 |
|
Vaccination for Travel (Hep A, HEP B, Twinrix)2 |
$50 |
|
Uninsured Vaccination (HPV, Zostavax, Menactra)2 |
$50 |
|
Uninsured Pap Smears (physician's charge)3 |
$60 |
| Medical / Cosmetic |
Uninsured HPV Test (physician's charge)4 |
$50 |
|
Wart Treatment (per wart) |
$30 |
|
Missed Appointment Fee5 |
$60 |
|
Missed Physical Fee5 |
$95 |
| Missed Appointments |
Missed Counseling Appointment (per 20-minute block)7 |
$75 |
|
Re-Book Missed Specialist Appointment |
$25 |
|
Reissue Lost Prescription |
$20 |
|
Reissue Lost Blood Work / Other Test Requisition |
$20 |
|
Faxing and Photocopying (up to 5 pages, per page) |
$35 |
| Records |
Faxing and Photocopying (over 5 pages, per page) |
$1.50 |
|
Legal Letters ($100 minimum) |
$300/hr |
|
Immunization Record Replacement |
$25 |
