individually, or chose to pay an annual block fee per family. Fee Schedules are set by Ontario
Medical Association ( subject to change without prior notice).
Consultations and Clinic Visit charges for patients who do not have OHIP coverage:
Consultation A005 $98.37
General Assessment A003 $97.32
Intermediate Assessment A007 $49.15
Minor Assessment A001 $31.13
Annual Examination-Child > 2 yr. K017 $53.23
Transfer Of Medical Records is NOT covered by OHIP:
Charges are for the photocopying of records $29.60 for pages 1-5
$1.17 for each page thereafter.
Telephone prescription and renewal: $10
Fee charged for Completion of Forms:
Schools=$17.75
Camps=$17.75
Pre-employment Certification of Fitness=$23.67
Fitness Clubs=$23.67
Hospital/Nursing Home Employees=$23.67
Completion of Licensing Forms/Certificates:Drivers Medical Examination (FLRC80)=$35.51
Pilots Civil Aviation; form 26-0010(0890)=$59.19
Pilots Licence Validation 26-0055(01-91)=$11.84
Administrative Licence Suspension Appellant Medical Information Form=$29.03
Back-to-Work Notes=$11.84
Sick Notes=$11.84
Federal Employee Absence Notes; blue form=$17.75
Day Care Note (free of communicable disease)=$11.84
Insurance Certificates:Treatment Plan, form #OCF-18/59=$88.80
Disability Certificate, form #OCF-3/59 (former Health Practitioner's Certificate)=$88.80
Certificate of Health Practitioner, form #OCF-8=$29.03
Travel Cancellation Insurance Form=$23.67
Life Insurance Death Certificate=$29.60
Citizenship and Immigration Canada Medical Report for Immigration=$88.80
CPP Disability Medical Report Form(government pays $65, patients pay $23.80)=$88.80
Medical Information Regarding Applicants to Canadian Armed Forces=$69.68
Central Collection Service Request for Physician's Information=$88.80
Revenue Canada, Federal Disability Tax Credit=$29.60
Auto Sales Tax Rebate Form=$23.67
Childrens' Aid Society (CAS) Application Form for Prospective Foster Parent=$35.51
UIC Disability/Maternity Certificate INS2019=$17.75
