Uninsured services

Fees & forms

Find a form, report or uninsured service. Open a category to review the details and listed fees.

Before you book

These services are not generally covered by OHIP. Fees are in Canadian dollars. The final fee, eligibility, vaccine product and availability will be confirmed by the clinic before service. Pre-employment certification ranges from $60 to $200 depending on whether a full physical assessment is required.

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67 listed services

Forms and reports16 listed servicesCertificates, insurance documents and medical reports completed outside OHIP coverage.

Minimum Fee for Any Form

Minimum fee for form completion unless a separately listed service or more complex requirement applies.

$40

Admission to Institution

Completion of an admission form using the clinical information required by the institution.

$40

Schools / Camps

Health form or certificate requested for school, camp or a similar program.

$40

Complex Forms

Detailed form completion requiring additional chart review or clinical information; charged per page.

$50 per page

Application for Foster Parent

Medical information and certification required for a foster-parent application.

$80

CPP Disability Medical Report

Completion of the Canada Pension Plan disability medical report.

$200

CPP Narrative Medical Report

A detailed narrative medical report prepared for a CPP disability application.

$200

Employment Insurance Sickness Benefits

Medical certification for an Employment Insurance sickness-benefit application.

$50

CRA Disability Tax Credit

Completion of the medical-practitioner portion of the federal Disability Tax Credit form.

$200

Immunisation Record Form Filing

Review and completion of a requested immunisation record form.

$60

Life Insurance / Death Certificate

Completion of the applicable life-insurance or death-certificate documentation listed in the clinic fee schedule.

$80

All OCF Forms (including OCF-3 Disability Certificate)

Completion of an Ontario auto-insurance OCF form, including the OCF-3 disability certificate.

$200

Pre-employment Certification

The fee starts at $60 and may be up to $200 when a full physical assessment is required.

$60–$200

Disease-Specific Questionnaire

Completion of a questionnaire requiring information about a specific diagnosis or condition.

$120

Driver's Physical

Physical assessment and documentation required for a driver's medical form.

$200

Trip Cancellation Insurance Form

Medical documentation required to support a trip-cancellation insurance claim.

$60

Vaccines for non-OHIP patients28 listed servicesPrivate-pay vaccine options. Product availability, dose requirements and suitability must be confirmed with the clinic.

ACT-HIB 0.5 L

Private-pay ACT-HIB vaccine option listed in the clinic fee schedule.

$78

Adacel-Polio

Private-pay combined Adacel-Polio vaccine.

$78

Chicken Pox

Private-pay chicken pox (varicella) vaccine.

$144

Cholera

Private-pay cholera vaccine.

$78

Hep A

Private-pay hepatitis A vaccine.

$80

Hep A & B

Private-pay combined hepatitis A and B vaccine.

$78

HPV

Private-pay human papillomavirus vaccine.

$270

Japanese Encephalitis

Private-pay Japanese encephalitis vaccine.

$288

Meningitis B

Private-pay meningococcal B vaccine.

$192

Meningococcal ACYW-135

Private-pay meningococcal ACYW-135 vaccine option.

$192

Meningococcal ACYW-135 (HALAL)

Private-pay halal meningococcal ACYW-135 option listed in the fee schedule.

$174

Menjugate

Private-pay Menjugate meningococcal vaccine.

$114

MMR

Private-pay measles, mumps and rubella vaccine.

$78

MMRV

Private-pay measles, mumps, rubella and varicella vaccine.

$78

Pneumococcal - listed option 1

One private-pay pneumococcal vaccine option listed in the fee schedule; confirm the product with the clinic.

$78

Pneumococcal - listed option 2

A second private-pay pneumococcal vaccine option listed in the fee schedule; confirm the product with the clinic.

$156

Polio - listed option 1

One private-pay polio vaccine option listed in the fee schedule; confirm the product with the clinic.

$78

Polio - listed option 2

A second private-pay polio vaccine option listed in the fee schedule; confirm the product with the clinic.

$102

Rabies

Private-pay rabies vaccine.

$300

Rotavirus

Private-pay rotavirus vaccine.

$108

Shingles - listed option 1

One private-pay shingles vaccine option listed in the fee schedule; confirm the product with the clinic.

$198

Shingles - listed option 2

A second private-pay shingles vaccine option listed in the fee schedule; confirm the product with the clinic.

$258

Tetanus & Diphtheria

Private-pay tetanus and diphtheria vaccine.

$78

Tetanus, Diphtheria, Pertussis

Private-pay combined tetanus, diphtheria and pertussis vaccine.

$81

Travellers' Diarrhea / Cholera

Private-pay oral vaccine option for travellers' diarrhea and cholera.

$74

Typhoid (Injectable / Oral)

Private-pay typhoid vaccine; injectable or oral option as appropriate and available.

$87

Yellow Fever

Private-pay yellow fever vaccine.

$276

All Other Vaccines

Listed fee for another private-pay vaccine not named above; confirm the product and price before your visit.

$102

Clinical and assessment services23 listed servicesVisits, procedures, notes, chart services and assessments that may not be covered by OHIP.

Uninsured Health Assessment or Physician Consultation

An uninsured health assessment or consultation with a physician.

$100

Attending Physician's Statement

A detailed physician statement commonly requested by an insurer or benefits provider.

$192

Civil Aviation Report (per hour)

Preparation of a civil-aviation medical report; charged per hour.

$180

Copy from Chart (up to 20 pages)

Preparation of a copy of the patient's chart, up to 20 pages.

$36

Ear Syringing (no hearing loss, per ear)

Ear irrigation when the service is not OHIP insured; charged per ear.

$36

EI Compassionate Care Benefits

Medical certification for an Employment Insurance compassionate-care benefit application.

$72

Insurance Medical Examination

Medical examination and documentation requested for insurance purposes.

$300

Lost Requisition/Referral

Replacement of a lost requisition or referral document.

Orthotics Prescription

An uninsured prescription requested for orthotics.

$30

Massage Therapy Prescription

An uninsured prescription requested for massage therapy.

$30

1 Step/2 Step TB Test for Work (Injection)

Tuberculosis skin-test injection required for employment screening.

$72

1 Step/2 Step TB Test for Work (Read)

Scheduled reading and documentation of a work-related tuberculosis skin test.

$24

Pilot's Licence Validation (per hour)

Medical validation work requested for a pilot's licence; charged per hour.

$180

Pre-op Assessment

Uninsured pre-operative assessment and related documentation.

$180

Sick Note: University Specific

Medical note completed to a university's specific requirements.

$48

Full Narrative/Clarification (per hour)

Detailed narrative report or clarification requiring extensive review; charged per hour.

$480

System-Specific Examination

Examination focused on a particular body system for an uninsured request.

$144

Sick Note: Work/Back to Work

Medical note for absence from work or return-to-work clearance.

$40

Travel Advice & Vaccine Admin (>5 people)

Travel-health advice and vaccine administration for a group of more than five people, as listed in the fee schedule.

$168

Travel Advice & Vaccine Admin (per patient)

Travel-health advice and vaccine administration fee for one patient.

$96

Skin Tag Removal (each)

Uninsured removal of a skin tag; charged for each lesion.

$60

Travel Advice & Vaccine Admin (<5 people)

Travel-health advice and vaccine administration for a group of fewer than five people, as listed in the fee schedule.

$144

Wart Removal by Liquid Nitrogen (each)

Uninsured liquid-nitrogen treatment of a wart; charged for each lesion.

$36

Questions about a form?

Confirm what you need with the clinic.

Ph: 416-288-0010