Patient Uninsured Services Pricing

While OHIP covers the costs for most of your medical needs, there are many services which are not covered. These require our valuable time and resources, often outside of regular office hours.

Examples of these include, but are not limited to:

  • Prescription renewals without an appointment
  • Referrals for Physiotherapy, Massage Therapy, Chiropractic, etc.
  • School / Work / Insurance Forms
  • Travel counselling and immunization

We value your time and continue to improve patient experiences with the addition of useful features such as confidential Ocean e mail, appointment reminders, the option of live/phone/video appointments and soon, online appointment bookings.

We are also excited to let you know about a new program we are transitioning to on August 21, 2023. PatientSERV, the Ontario Medical Association’s partner in uninsured services management, allows patients to easily manage their uninsured services payments through an online platform and dedicated support team.

These prices are all subject to change without notice. 

Forms

Admission to Schools / Camps / Daycares

$35.00

Application for Prospective Adoptive Parent

$65.00

Attending Physician Statement for Work (Priced in minutes to complete)

Under 10 minutes - $80.00
11 to 20 minutes - $90.00
21 to 30 minutes - $120.00
31 + minutes - $160.00

$80.00 – $160.00

Liquid Nitrogen (Benign Lesions, Warts)

$10.00-$50.00

Medico-legal Letters, Complex Forms And Other Special Correspondence

$35.00 / 5 minute increment

Minor Cosmetic Surgery

$100.00+

Other forms not specified

$35.00 / 5 minute increment

Pre-Employment Certification of Fitness

$170.00

Retirement Home Admission Forms And Pre-admission Testing

$100.00

Special Authorization For Drug Coverage Form

$44.00

Government Forms

CRA Disibility Tax Credit Application

$98.00

Employment Insurance Compassionate Care Benefits

$50.00

Medical Certificate Employment Insurance Sickness Benefit INS5140

$44.00

OSAP – Verification Of Disability

$50.00

Immunization

Immunization Review (With Or Without Paperwork)

$70.00

Immunizations (When Not Covered By OHIP, Per Injection)

$25.00

Replacement Of Immunization Certificate

$30.00

Insurance Forms

Attending Physician Statement Form (Insurance Co)

$80.00-$160.00

Life Insurance Death Certificate Form

$55.00

Travel Cancellation Insurance Form

$42.00

Medical Records

**Physician Review Of Records (Where Applicable)

$50.00

Email Of Chart Notes (At Patients Request)

$10.00

Forwarding Chart Notes (At Patients Request)

$10.00

Transfer Of Medical Records (Electronic)**

$30.00

Transfer Of Medical Records (Photocopies) – Up to 20 pages

20+ Pages - $0.25 per page

$30.00

Transfer Of Medical Records To CD (Disk)**

$35.00

Miscellaneous

Employment Physical & Form

$170.00

Missed Appointment – Under 4 Hours Notice Given

$50.00

MTO – Additional Assessment Form

$65.00

MTO – Drivers License Physical & Form

$160.00

Rebooking Missed Appointments With Specialists/medical Investigations

$30.00

TB Test (When Not Covered By OHIP)

$50.00

Notes

Absence from School / Work

$22.00

Day Care (Free from Communicable Disease)

$120.00

General Doctor’s Note

$22.00

Return to School / Work

$22.00

Prescription Related

Presciption Renewal Request by Phone (medication)

Prescription renewals with a booked appointment are free.

$15.00

Prescriptions (Other then medication)

$12.00

Replacement Of Lost Prescriptions / Lab Requisitions

$22.00

Travel

Travel Cancellation Insurance Form

$42.00

Travel Consultation

Pre-departure Travel Medicine Services Rendered Solely For The Purpose Of Travel Outside Of Canada Are Not Covered By OHIP.

$75.00

Travel Vaccinations

$25.00

THERE IS NO CHARGE FOR THE FOLLOWING FORMS:

  • Application for Accessible Parking Permit
  • Transit form for the disabled
  • Permanent resident card forms
  • Request for birth certificate forms
  • Children’s Aid Society Forms (on behalf of child)
  • Ministry of Health and Long-Term Care Forms (e.g. Limited Use, Assistive Devices)
  • Application for Hearing Device funding

Request Uninsured Service

Name(Required)

PatientSERV

Through PatientSERV, we will also be offering the PS365 plan. This optional annual fee plan covers the costs of most uninsured services for one year. We believe that the PS365 plan is fairly priced and hope that you will seriously consider the valuable benefits for both you and your family.

Of course, you may choose not to participate in the PS365 plan program. In this case, any uninsured services you receive will be charged on a Pay-As-You-Go basis.

To choose the PS365 plan or stay on a Pay-As-You-Go basis, please respond by one of the following methods:

  • Complete the accompanying registration form and return it by mail in the postage-paid envelope. You can also send the completed form by fax to 1-877-461-7687

– OR –

  • Enroll online at www.patientserv.ca (select Login, then Sign Up to be a PatientSERV Patient). You will require your Health Card number as well as the following unique PIN:

If you have any questions about this program, or would like to pay over the phone, please contact PatientSERV at 1-800-385- 3210.

Regardless of the choice you make, please be assured that it will have no bearing upon the medical care you receive from us as your healthcare is our top priority. We value the trust that you have placed in us to provide you with the highest quality healthcare possible.