COST OF UNINSURED SERVICES
FORMS |
|
| DR’S CERTIFICATION SICK NOTE | $20 |
| MPI DRIVERS PHYSICAL/FORM | $120 |
| MPI ALCOHOL/DRUG REPORT FORM | $20 |
| DISABILITY INSURANCE CLAIM FORM | $20/page |
| MODIFIED WORK DUTY FORM | $20/page |
| PARKING PERMIT | $40 |
| CRA DISABILITY TAX CREDIT FORM | $80 |
| CRA DISABILITY TAX CREDIT FOLLOW-UP | $40 |
| PRE-OP PHYSICAL EXAM/FORMS (PRIVATE SURGERY) | $120 |
| SCHOOL/EMPLOYMENT/ADOPTIONS/SPORTS PHYSICAL/FORMS | $120 |
MANTOUX |
|
| MANTOUX (ALL VISITS, FORMS, RESULTS, INJECTIONS | $220 |
IMMUNIZATIONS |
|
| IMMUNIZATIONS (VISIT ONLY) NOT COVERED BY MB HEALTH | $40 |
TRAVEL ADVICE |
|
| TRAVEL ADVICE CONSULT (VISIT ONLY) | $40 |
PATIENTS WITHOUT VALID MHSC COVERAGE |
|
| CONSULTATIONS | $120 |
| FOLLOW-UP APPOINTMENT | $60 |
| SUTURES | $300 |
| **Any lab/diagnostic testing/forms not included | |
CLERICAL |
|
| PHOTOCOPIES | $1/page |
| CHART TRANSFER FEE | $40 |
| +courier/mailing charges if applicable | TBA |
MISSED APPOINTMENTS (24 HOURS OR LESS) |
|
| MISSED REGULAR APPOINTMENT | $40 |
| MISSED COMPLETE PHYSICAL APPOINTMENT | $80 |
| *24 Hour cancellation notice required **Please note- The 3rd missed appointment may result in termination from practice |
|
