Patient information
Uninsured Services
Private Pay/Uninsured Services
Services are not covered under MSP
Forms
-
Workplace Fitness Assessment Form
*Examination Extra
-
Completion of Simple Form
*Per page
-
Insurance Company Form – Including Review of Records (Short)
-
Insurance Company Form – Including Review of Records (Extensive)
-
Sick Time Form
*If not part of office visit
-
Disability Tax Credit Certificate
-
Income Tax Disability – Long Form
*For patients with Disability Designation
-
Private Insurance Drug Coverage Form
-
Fitness Form for School, Summer Camp, etc. – Without Examination
-
Fitness Form for School, Summer Camp, etc. – With Examination
Examinations & Visits
-
General Insurance Examinations
Industrial, MOT, CPP, Pilots, Air Traffic Controllers, Marine Personnel
-
Medical Exam and Driver’s Exam Form (Class 1-7 Yellow)
This service is available to registered clinic patients only; we do not operate as a walk-in clinic.
-
Office Visit – No MSP Coverage
*Price based on age
-
Complete Physical – No MSP Coverage
Letters and Notes
-
Medical Advice by Letter
* Rate Based on Preparation Time
-
Sick Time Note
*If not part of office visit
-
Medical Notes for Chiropractor/Massage/Orthotics
Procedures
-
Liquid Nitrogen – Warts, Skin Tags – Adults over 15 years old
*Plantar wards excluded
-
Actinic Keratosis – For Cosmetic Purposes
*Rate depends on complexity and practitioner’s discretion
Other Services
-
Prescription Refills via Phone or Fax – Deregistered/Active patients
-
Excision and Tray Fee – Cosmetic Procedures
-
Wound Care Supplies Fee
Based on wound care complexity
-
Courier or MediTran Fee
-
Chart Transfer Requests – Base Fee – Photocopy or Disc
Plus $2.36 per page for first 10 pages, and $0.32 thereafter
-
Access to Medical Records – Base Fee – Patient Request (Photocopy)
Plus $2.36 per page for first 10 pages, and $0.32 thereafter
-
Access to Medical Records – Base Fee – Patient Request (Copied to Disc)
*Additional fees commensurate with administrative time
Forms
-
Workplace Fitness Assessment Form
*Examination Extra
-
Completion of Simple Form
*Per page
-
Insurance Company Form – Including Review of Records (Short)
-
Insurance Company Form – Including Review of Records (Extensive)
-
Sick Time Form
*If not part of office visit
-
Disability Tax Credit Certificate
-
Income Tax Disability – Long Form
*For patients with Disability Designation
-
Private Insurance Drug Coverage Form
-
Fitness Form for School, Summer Camp, etc. – Without Examination
-
Fitness Form for School, Summer Camp, etc. – With Examination
Examinations & Visits
-
General Insurance Examinations
Industrial, MOT, CPP, Pilots, Air Traffic Controllers, Marine Personnel
-
Medical Exam and Driver’s Exam Form (Class 1-7 Yellow)
This service is available to registered clinic patients only; we do not operate as a walk-in clinic.
-
Office Visit – No MSP Coverage
*Price based on age
-
Complete Physical – No MSP Coverage
Letters and Notes
-
Medical Advice by Letter
* Rate Based on Preparation Time
-
Sick Time Note
*If not part of office visit
-
Medical Notes for Chiropractor/Massage/Orthotics
Procedures
-
Liquid Nitrogen – Warts, Skin Tags – Adults over 15 years old
*Plantar wards excluded
-
Actinic Keratosis – For Cosmetic Purposes
*Rate depends on complexity and practitioner’s discretion
Other Services
-
Prescription Refills via Phone or Fax – Deregistered/Active patients
-
Excision and Tray Fee – Cosmetic Procedures
-
Wound Care Supplies Fee
Based on wound care complexity
-
Courier or MediTran Fee
-
Chart Transfer Requests – Base Fee – Photocopy or Disc
Plus $2.36 per page for first 10 pages, and $0.32 thereafter
-
Access to Medical Records – Base Fee – Patient Request (Photocopy)
Plus $2.36 per page for first 10 pages, and $0.32 thereafter
-
Access to Medical Records – Base Fee – Patient Request (Copied to Disc)
*Additional fees commensurate with administrative time