Patient Information
Non-OHIP Covered & Insured Services
Uninsured Services
Completion of Forms for Physicals
| School/Camps/Pre-School/Daycare/Educational Institution | $40.00 |
| Driver’s Medical Exam Form | $200.00 |
| Attending Physician Statement/ Short Term Disability | $200.00 |
| Disability Certificate Form OCF-3 | $260.00 |
| Disability Tax Credit/ODBS Form | $85.00 |
| CRA Letter | $150.00 |
| Insurance Relates Sick Note/Form | $75.00 |
Completion of Work-Related Forms/Notes
| Sick Notes / Back to Work Notes / Day Care Note (free of communicable disease) | $30.00 |
| Work Related Forms/Sick Forms/TTC Forms | $30.00 |
| Federal Employee; Blue Form | $35.00 |
| Admission to Day Care / Pre-School | $40.00 |
| Admission to Community College/University/Institute | $35.00 |
Travel Related
| Travel Cancellation Insurance Form | $150.00 |
| Travel Consult | $85.00 |
| Travel Immunization (per injection) | $25.00 |
Services/Procedures Not Cover by OHIP
| Regular Office Visit (Non-OHIP) | $75.00 |
| Follow Up Office Visit (Non-OHIP) | $50.00 |
| Wart Removal/Skin Tags | $25-($10.00 for additional) |
| Ear Syringing | $35.00 per ear |
| Prescription Renewal by Fax | $25.00 |
| Urine/Pregnancy Dipstick/Rapid Strep Test | |
| TB Skin Test (For Educational purposes is Covered by OHIP-Proof Req.): | $10.00 |
| 1-Step Test | $25.00 |
| 2-Step Reading | $25.00 |
| TB Skin Test/ Reading for Non-OHIP Visit | $85.00 |
| Proof of TB Skin Test/Reading | $20.00 (Note) $35.00 (Forms) |
| Photocopying of chart/chart transfer** | $30.00 + |
Transfer of Medical Records Authorization
Privacy Policy Information
Non-OHIP covered services are those services provided to patients that are not covered by the Ontario Health Insurance Plan (OHIP). The Ministry covers all insured medically necessary services provided by physicians, however, it does not pay for services that are not medically necessary. These may include: writing sick notes, cosmetic procedures, charges for missed appointments, completing forms for daycare, insurance, legal or employment purposes, or if your health card is not valid on the day of your appointment.
OHIP pays physicians for most medical services delivered to patients. Services not covered by OHIP or another insurance plan are called uninsured services. Your physician will request a payment from you for those services. It is the patient’s responsibility to pay for uninsured services.
When fees are charged for uninsured services, they are based on the Ontario Medical Association’s suggested fees as found in the most current edition of the OMA Physician’s Guide to Third Party and Other Uninsured Services.
For more details please see the Ministry’s website or contact your nearest Ministry office