2157 Royal Windsor Drive Mississauga, Ontario L5J 1K5

Uninsured Services


As you are aware, essential medical services in Ontario are insured through the Ontario Health Insurance Plan (OHIP). There are many services however that are not covered by OHIP, which nevertheless consume a considerable amount of time for your physician and the office staff. It is our office policy to charge patients for these services in accordance with the 2009 Ontario Medical Association guidelines.


Description of Service – Fee Per Service

Pharmacy Requests

  • Prescription Repeats by Phone/Fax


  • Printouts of Tests or Reports
  • Photocopies of Records or Forms
  • Transfer of Medical Records

Cosmetic and Other Non-insured Surgical Procedures

  • Wart/Skin Tag Removal (minor)
  • Wart/Skin Tag Removal (major)

Uninsured Injections and Tests

  • Travel Consult
  • Injections for Travel Outside of Canada
  • Injections not covered by OHIP
  • TB Test
  • TB Read

Work &School Related Forms/Notes

  • Back to Work Notes/Sick Notes
  • Daycare Note (Free of Communicable Disease)
  • Referral Note for Chiropractor/Physiotherapy/Massage/Orthotics/Etc.
  • TB Test Result Form

Forms Requiring Physical Exam

  • Drivers Medical Exam + Form
  • Pre-Adoption Medical Exam + Form
  • Third Party Medical Exam + Form
  • Pre-operative Exam for Cosmetic Surgery + Form
  • Any Other Form Requiring a Physical Examination

Insurance Certificates and Forms

  • Revenue Canada, Federal Disability Tax Credit
  • Children’s Aid Society Application Form for Prospective Foster Parent
  • Treatment Plan (form OCF-18)
  • Disability Certificate (form #OCF-3)
  • Determination of Catastrophic Impairment (Form # OCF-19)
  • UIC Disability / Maternity Certificate
  • Attending Physician Statement
  • Pre-employment Certificate of Fitness
  • Citizenship and Immigration Report
  • Miscellaneous Insurance/Disability or Sickness Forms