Uninsured Services & Fees

Services Not Covered By OHIP
Orleans Family Health Clinic and your Family Doctors are committed to provide you with the best medical care, promptly and in a pleasant and professional environment.

Orleans Family Health Clinic supports public health care and is proud of Ontario’s Health Insurance Plan (OHIP). It is important for patients to understand that there are certain medical examinations and services that are not deemed medically necessary by the Ontario Health Insurance Plan and are therefore uninsured. These services, such as: insurance forms, legal letters, sick notes, cosmetic medical procedures, etc., are called “non-insured or uninsured services”. Your doctor at Orleans Family Health Clinic will charge for uninsured services in accordance with the fees guidelines set by the Ontario Medical Association (OMA) and the College of Physicians and Surgeons of Ontario (CPSO).

The folowing list accounts for most commonly requested uninsured services. However, if the service you request is not on the list below, please communicate it to the clinic’s staff or your doctor and you will be given further clarification.

All uninsured services must be paid in full when rendered. A receipt will be provided upon settlement of the account. Please be advised that, currently, our office only accepts cash for these services.

Missed Appointment with short notice$50.00
Missed Physical Examination without 24h notice$85.00
Transfer of Medical Records
Chart Summary Transfer$75.00
First 20 Pages$30.00
Each Page After 5$0.25
Out of Pocket Disbursements (postage, courier, etc.)At Cost
Physician Review of Records$250/h
Prescriptions Without Appointment
Prescription Renewal by Fax (Only When Appropriate)$20.00
Lost Prescriptions / Referral Notes$20.00
Massage Therapy, Orthotics, Physio, Comp. Stockings, etc.$20.00
Basic Visit (no or invalid OHIP) weekdays/evenings or holidays$75.00
Major Visit/Adult Physical (no or invalid OHIP)$120.00
Child Annual/Camp Physical (no or invalid OHIP)$70.00
Physical Examination Required by Third Party$150.00
Driver’s Medical Exam (MOT, FLRC80 Form Completion only)$45.00
Driver’s Medical Exam (MOT, FLRC80 Form + Physical)$150.00
Travel Advice (referral to our Travel Clinic)

It takes time for our doctors to make a thorough assessment and provide patients with the proper medicine they need. To schedule a consultation at our travel clinic, click here!. Please note: OHIP does not cover costs of travel medicine or travel advice.

Wart-cryotherapy (first wart)$30.00
Each additional wart$10.00
Seborrheic Keratosis$40.00
Skin Tags Removal and other cosmetic procedures$50.00
Excision & Suture of Moles, Cysts, Lipomas (first lesion)$80.00
Each additional$30.00
Employment Forms
Back to Work /Sick Notes$15.00
Federal Employee Absence Notes$40.00
Certificate of Freedom from Communicable Disease $15.00
School, Camp Physical (Form only) $25.00
Admission to educational institution/Daycare/University$25.00
Medical Certificate EI Sickness Benefits INS5140$25.00
Medical Certificate EI Maternity$25.00
Medical Certificate for EI Compassionate Care Benefits $50.00
Jury Duty Exemption Letter$25.00
Pre-employment and Fitness Club Certification of Fitness$35.00
Government Forms
Citizen and Immigration Canada Medical Report$130.00
Medical Information re: Applicants to Canadian Armed Forces $100.00
Central Collection Service Request for Physician’s Information $130.00
Revenue Canada, Federal Disability Tax Credit$45.00
Auto Sales Tax Rebate Form $35.00
Canada Pension Plan (CPP) Forms
Disability Medical Report Form$85.00
Narrative Medical Report(up to)
Other Certificates
Children’s Aid Society (CAS) Application for Foster Parent$50.00
Children’s Aid Society Forms (on behalf of a child)No Charge
Insurance Certificates
#OCF-18 Treatment Plan $130.00
#OCF-3 Disability Certificate$130.00
#OCF-8 Certificate of Health Practitioner$45.00
#OCF-19 Determination of Catastrophic Impairment $100.00
Travel Cancellation Insurance Form$35.00
Life and Health Insurance Report and Assessment Fees
Attending Physician’s Statement $150.00
System-Specific or Disease Specific Questionnaire $85.00
Insurance Medical Examination $200.00
System Specific Examination$100.00
Clarification Report$350.00/h
Full Narrative Report$350.00/h
Life Insurance Death Certificate$45.00
Independent Medical ExaminationOMA Guidelines
Other Insurance FormsOMA Guidelines
Other Forms
Letter on Behalf of PatientOMA Guidelines
Lawyer’s LetterOMA Guidelines
Application for Accessible Parking PermitNo Charge
Transit Forms for the DisabledNo Charge
Permanent Resident Card FormsNo Charge
Request for Birth Certificate FormsNo Charge
Ministry of Health and Long-Term Care FormsNo Charge

1. Disability tax credit form – Filling the form does not ensure qualification for the program.

2. Prescription renewals will be provided by Fax or Phone only when appropirate and at the request of the patient or patient representative only.

3. Fees for Letters on behalf of the paient will be provided when appropriate and the fee depends on the work required.

4. Orleans Family Health Clinic and your Physician will consider the financial burden that such charges may place on the patient and may decide if it is appropriate to reduce, waive or allow flexibility based on these considerations as applied to the circumstances of each case. The Canadian Medical Association’s Code of Ethics (2004) states that “an ethical physician will consider, in determining professional fees, both the nature of the service provided and the ability of the patient to pay, and will be prepared to discuss the fee with the patient.”

Uninsured Services Clarification:
1. Prescription renewals are uninsured when requested by a non-rostered patient, and are not associated with an insured service, and no other insured service is provided.

2. Forms and certificates are uninsured when they are provided at the request of the patient and are transmitted to a third party such as an employer, private insurer, and others.

3. TB skin test is uninsured when requested by the patient and/or is not medically necessary ie. for school or work reasons.

4. Faxing & photocopying is uninsured when it is provided for the patient’s personal use or for a third party.

5. Transfer of medical records is uninsured when it is at the request of the patient.Referral notes are uninsured when the note is requested by the patient to obtain services that are not medically necessary.

6. Removal or treatment of warts is insured by OHIP only for plantar warts, genital warts and all warts in immunocompromised patients.



If you have a life-threatening medical emergency, contact 911 immediately!

Dial 911 to call an ambulance. Calling this number is free from any phone. Once in contact with the 911 operator, notify them of any health problems you or someone you know is facing. They will be able to evaluate the urgency of the situation and send an ambulance if needed.

For non-life-threatening conditions, same day emergency appointments are available with your doctor. (Please note that same day emergency appointments MUST be booked in the morning.)

After hours or on holidays, please call Telehealth Advisory (1-866-797-0000) to speak with a registered nurse. This service is free, confidential and available 24/7.