Pricing for Uninsured Services

Based on the Ontario Medical Association (OMA) Guidelines Jan to Dec 2022

Completion of Form Physicals for:

  • Schools/Camps, $30.00

  • Admission to Day-Care, Preschool, University or any other educational institution, $30.00

  • Pre-employment Certification of Fitness/Fitness Clubs, $40.00

  • Hospital/Nursing Home Employees, $40.00

Completion of Licensing Forms/Certificates:

  • Drivers Medical Examination, $160.00

  • Civil Aviation Medical Examination Report, $150.00/hr

  • Pilots License Validation, $150.00/hr

Completion of Work and School Related Forms/Notes:

  • Back to Work Notes/Sick Notes, $30.00

  • University Specific Sick Note, $40.00

  • Immunization Record Update and Completion of Forms for Work/School, $50.00

Insurance Certificates:

Note: An $100.00 assessment fee can be charged in addition to the insurance form fee if an assessment is necessary to obtain relevant information needed to complete the form

  • OCF-18 Treatment Plan, $150.00

  • OCF-3 Disability Certificate, $150.00

  • OCF-19 Determination of Catastrophic Impairment, $120.00

  • OCF-23 Treatment Confirmation, $145.00

  • Travel Cancellation Insurance Form, $50.00

  • Life Insurance Death Certificate, $50.00

  • Medical Certificate for Employment Insurance Compassionate Care Benefits, $60.00

  • Attending Physician’s Statement, $150.00

  • System – Specific or Disease Specific Questionnaire, $100.00

  • Insurance Medical Examination, $250.00

  • System-Specific Examination, $120.00

  • Full Narrative/Clarification Report, $400.00/hr.

Government Forms:

  • CPP Disability Medical Report Form (up to), $85

  • CPP The Narrative Medical Report (up to), $150

  • Revenue Canada, Federal Disability Tax Credit, $75.00

  • Children’s Aid Society Application for Prospective Foster Parent, $60.00

  • Medical Certificate Employment Insurance Sickness Benefits, $40.00

TB Mantoux Testing

  • TB Test requested by Ministry of Health Program (e.g. Public Health) - FREE

  • TB Test requested for admission or continuation in a day care, pre-school, school, college, university or other educational institution

  • Charge for Form/Report Completion - FREE

  • One Step TB Test for work, $60.00 for injection, $20.00 for read

  • Two Step TB Test for work, $60.00 for injection, $20.00 for read, $60.00 for 2nd injection, $20.00 for second read

Paps

  • If past the annual OHIP insured limit, $60.00

Ear Syringing

  • If obstructing hearing - FREE

  • If not obstructing hearing, $30/ear

Unremunerated Report Forms:

Physician is NOT permitted to charge a patient for completion

  • Application for Accessible Parking Permit/Transit Forms for Disabled

  • PR Card Forms/Request for Birth Certificate Form/Canadian Passport Application

  • Children’s Aid Society Form (on behalf of a child)/Ministry of Health and Long-Term Care (e.g. Limited Use,

  • Assistive Devices etc.)

Chart Copies:

  • Copies from the Patient’s Chart (up to 20 pages), $1.00/pg.

  • Copy of the Full Chart (up to 20 pages), $30.00, if over 20 pages, $.25 per page for each page

Other:

  • Letter/referral/rx for massage therapy, orthotics, back support, stockings etc., $30.00

  • Non-Resident or Expired Health Card Visit Fee, $100.00

  • Pre-op Assessment (by General Practitioner), $150.00

  • Lost Requisition/Referral, $5.00