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 following 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 accepts cash and electronic funds for these services.

*All fees are subject to change without notice.

Missed Appointment with short notice$60.00
Missed Physical Examination without 24h notice$100.00
Transfer of Medical Records
Chart Summary Transfer
First 20 Pages
Each Page After 5
Out of Pocket Disbursements (postage, courier, etc.)
Physician Review of Records
Prescriptions Without Appointment
Prescription Renewal by Fax (Only When Appropriate)
Lost Prescriptions / Referral Notes
Massage Therapy, Orthotics, Physio, Comp. Stockings, etc.
Basic Visit (no or invalid OHIP) weekdays/evenings or holidays
Major Visit/Adult Physical (no or invalid OHIP)
Child Annual/Camp Physical (no or invalid OHIP)
Physical Examination Required by Third Party
Driver’s Medical Exam (MOT, FLRC80 Form + Physical)
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)
Each additional wart
Seborrheic Keratosis
Skin Tags Removal and other cosmetic procedures
Excision & Suture of Moles, Cysts, Lipomas (first lesion)
Each additional
Employment Forms
Back to Work /Sick Notes
Federal Employee Absence Notes
Certificate of Freedom from Communicable Disease
School, Camp Physical (Form only)
Admission to educational institution/Daycare/University
Medical Certificate EI Sickness Benefits INS5140
Medical Certificate EI Maternity
Medical Certificate for EI Compassionate Care Benefits
Jury Duty Exemption Letter
Pre-employment and Fitness Club Certification of Fitness
Government Forms
Citizen and Immigration Canada Medical Report
Medical Information re: Applicants to Canadian Armed Forces
Central Collection Service Request for Physician’s Information
Revenue Canada, Federal Disability Tax Credit
Auto Sales Tax Rebate Form
Canada Pension Plan (CPP) Forms
Disability Medical Report Form
Narrative Medical Report
Other Certificates
Children’s Aid Society (CAS) Application for Foster Parent
Children’s Aid Society Forms (on behalf of a child)
Insurance Certificates
#OCF-18 Treatment Plan
#OCF-3 Disability Certificate
#OCF-8 Certificate of Health Practitioner
#OCF-19 Determination of Catastrophic Impairment
Travel Cancellation Insurance Form
Life and Health Insurance Report and Assessment Fees
Attending Physician’s Statement
System-Specific or Disease Specific Questionnaire
Insurance Medical Examination
System Specific Examination
Clarification Report
Full Narrative Report
Life Insurance Death Certificate
Independent Medical Examination
Other Insurance Forms
Other Forms
Letter on Behalf of Patient
Lawyer’s Letter
Application for Accessible Parking Permit
Transit Forms for the Disabled
Permanent Resident Card Forms
Request for Birth Certificate Forms
Ministry of Health and Long-Term Care Forms



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.