Fee Guide for Uninsured Services

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 Price
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
Scroll to Top