Third Party Fees

The following is a list of services that are NOT covered by OHIP or WSIB. These fees are consistent with other Family Health Teams, and are either less than or equal to the rates published by the Ontario Medical Association.

Effective June 10th, 2024

Return to work / Sick Notes$23.50
Driver (MOT) Physical, includes form fee$200.00
Follow-up MOT disease specific forms● $80.00 – Initial MOT completed here
● $200.00 – Initial MOT not completed here
School / Camp Physicals$33.75
Pre-Employment Physicals$45.00
School Forms$34.00
Short-Term Disability Forms$80.00
Long-term Disability Forms – Attending Physician’s Statement$160.00
Disability Tax Credit Form$150.00
CPP Application$200.00
Life Insurance / Death Certificate$100.00
Insurance Certificate (OCF-3 Disability Certificate)$240.00
Travel Cancellation Form$150.00
Pre-Op Dental Form$65.00
Dental Questionnaire Forms (Antibiotic Prophylaxis, Anti-Thrombotic therapy)$25.00
Expired Health Card Visit Fee$65.00
Missed Appointment Fee (Both virtual and in-person, charge applies after 2nd missed appointment)$50.00
Transfer of Chart (Digital)
Copies of Medical Records
($30.00 for first 20 pages then $0.25 per page thereafter.
Includes first 15 mins. of professional review, additional per unit fee will be added beyond 15 mins.)

$30.00 for first 20 pages, then $0.25/page thereafter
Dukoral Prescription$20.00
Prescription for Massage, Physio, Chiropractor, Orthotics & Hearing Aid Forms (Each)$20.00
TB Skin Testing (3rd party request – employment, education, volunteer)
● 1-Step – $30.00
● 2-Step – $50.00
Twinrix Immunization$30.00
Botox for Migraines (Not including the cost of Botox)$150.00
Shave Excision$150.00
Excisional Biopsy$250.00
Wart Cryotherapy$25.00
Skin Tag Treatment● Per Lesion – $25.00
● Cryotherapy – $25.00
● Shave Excision (without local) – $25.00
● Electrocautery (with local) – $50.00