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.
OFFICE/ADMINISTRATIVE | |
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Missed Appointment with short notice | $60.00 |
Missed Physical Examination without 24h notice | $100.00 |
Transfer of Medical Records | |
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Chart Summary Transfer | |
First 20 Pages | |
Each Page After 5 | |
Out of Pocket Disbursements (postage, courier, etc.) | |
Physician Review of Records |
Prescriptions Without Appointment | |
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Prescription Renewal by Fax (Only When Appropriate) | |
Lost Prescriptions / Referral Notes | |
Massage Therapy, Orthotics, Physio, Comp. Stockings, etc. |
MEDICAL EXAMS | |
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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. | |
COSMETIC PROCEDURES | |
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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 |
FORMS | |
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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 | |
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Children’s Aid Society (CAS) Application for Foster Parent | |
Children’s Aid Society Forms (on behalf of a child) |
Insurance Certificates | |
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#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 | |
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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 | |
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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 |
EMERGENCY? CALL 9-1-1
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.