Uninsured services COVERED by your Wellness Plan
General Uninsured Services
| Service | Price |
|---|---|
| Prescription Renewals by phone/fax/online (when appropriate and only at the request of the patient) | $25.00 |
| Letters on behalf of patients (depending on time and work involved) | $25 – $200 |
| Wart Treatment | $30.00/treatment |
| Lost Prescriptions, Notes, Referrals | $25.00 |
| TB Skin Test(3rd Party Request) | $50.00 |
| TB Test + Reading | $40.00 |
| Medical Examination for Return to Work requested by Employer | $75.00 |
| Third Party Physical Exam | $160.00 |
| Photocopying – Transfer of Medical Records | $30.00 first 20pg, $0.25/pg after |
| Ear Cleaning | $40.00 |
Medical Report/Forms
| Service | Fee |
|---|---|
| Copies of reports | $1 per page |
| Citizenship and Immigration Report | $50.00 – $75.00 |
| Commercial weight loss program | $45.00 |
| Illness and Return to Work Notes | $25.00 |
| Employment Insurance / Maternity Certificate | $45.00 |
| Fitness Club Forms | $25.00 |
| Private Insurance Forms | $30 – $200 |
| Pre-employment Certificate of Fitness | $45.00 |
| Jury Duty Letter | $25.00 |
| Certificate of Medical Status | $25 – $35 |
| Massage Therapy and Orthotics | $25.00 |
| Revenue Canada Disability Form | $150.00 |
| Day Care Notes | $25.00 |
| School / Camp Forms(Excluding Examinations) | $35.00 |
| School / Camp Physical Examinations | $75.00 |
| Travel Cancellation Forms | $50.00 |
| Referral Note for Chiropractor, Physiotherapy, etc. | $25.00 |
| Children’s Aid Society Forms | $45.00 |
| Replacement of Immunization Certificate | $15.00 |
| Forms required for Volunteer Work | $45.00 |
The following uninsured services are NOT COVERED by the Basic Plan
Available as per standard Provincial guidelines
| Service | Price |
|---|---|
| No show/late cancellation | $40.00 |
| Missed Annual Physical Examination | $80.00 |
| Attending Physician Statement | $160.00 |
| Driver’s Medical Form (MOT) (non-member, $315.00) | Plan Member : $157.50 |
| Legal reports | SMA rate |
