Uninsured Service Fee Guide
The following Uninsured Services ARE covered by the Annual Fee.
Lost notes/ Requisitions $15 & Up
Prescription Renewals $20/renewal
Fitness club forms $40
Forms required for commercial weight loss programs $30
Camp Form $30
Forms required for volunteers at nursing homes/hospitals $40
Employment Insurance/ Maternity Certificate $30
Illness/return to work notes (simple) $20
CPP Disability Form ( Charge in excess of Gov’t paid fee) $30
Notes for insurance coverage of physiotherapy, massage therapy, acupuncture, compression stockings & orthotics (at request of patient) $35
Replacement of immunization card $25
Private respite care form (with examination) $85
TB testing form – School/Daycare Simple / Complex $45 / $65 & Up
Federal Tax Credit and Related Forms $50
School/College/University Medical Certificate $30
Day Care Application Form $30
Private Insurance sickness $40 & Up
Life Insurance Death Certificate $50 & Up