Third-Party Fees
(Fees updated January 2021)
$25
Prescription renewal without an appointment
$25
$25
Illness & Work Notes
$25
$25
Patient /insurance company requested notes for: physiotherapy, chiropractor, massage therapy, orthotics etc.
$25
$40
Revenue Canada Disability form
$40
$25
Daycare notes
$25
$25
School/camp forms
$25
$40
Fitness Club Form
$40
Major $170, Intermediate $75, Minor $50
Medical assessments:
(when not covered by OHIP)
Major $170, Intermediate $75, Minor $50
Examination $130, Form $70
MOT Driver’s Medical Exam & form completion
Examination $130, Form $70
$20
Administration of vaccine (when uninsured)
$20
$25
Jury Duty Letter
$25
$160
Attending Physician Statement
$160
No Charge
Forms required for volunteer work
No Charge
$100-$200
Disease specific questionnaire
$100-$200
$25
Liquid Nitrogen-1st area
(when not covered by OHIP)
$25
$10
Liquid Nitrogen-additional
(each additional spot)
$10
$100-$200
Veterans Affairs paperwork
$100-$200
$10 ($30 with paperwork)
1-Step TB Test (when required by work/school)
$10 ($30 with paperwork)
$20 ($40 with paperwork)
2-Step TB Test (when required by work/school)
$20 ($40 with paperwork)
$25
Certificate of Medical Status
$25
varies
Letters on behalf of patients
(depends on time & work involved)
varies
$30
Chart transfer -Paper, Single
(not including MD chart review). (If greater than 20 pages, additional pages/photocopies plus shipping & postage)
$30
$60
Chart transfer -Paper, Family
(not including MD chart review). (If greater than 20 pages, additional pages/photocopies plus shipping & postage)
$60
$50
Chart transfer-USB-Single
$50
$60
Chart transfer-USB-Family
$60
$100
Pre-employment certificate of fitness
(ie: Parmalat)
$100
$100+
Private insurance forms
(depending on time & work involved)
$100+
$220, $40
Children’s Aid Society forms
Pre-adoption exam, Application for prospective parent
$220, $40
$60, $80
Travel consult
Single, Family
$60, $80
$100-$140
Auto accident insurance forms (OCF)
(depending on time)
$100-$140
$50
Travel cancellation forms
$50
$100-$250
Legal reports
(depending on time)
$100-$250
$75,$50
Disability Tax credit certificate
(clarification report)
$75,$50
varies
Other insurance/disability forms
(OMA rates)
varies
$25
Cortisone injection
(using our supply)
$25
Range: $50 - $150
Cosmetic lesions under local
(ie: skin tags,cyst etc)
Range: $50 - $150