Uninsured Services
The following are examples of forms, letters, reports, notes and/or services and the Classification they fall into.
If the request you have is not listed, or you have questions and/or concerns please contact the clinic for assistance.
The Annual Block Fee covers some of these uninsured services.
**denotes uninsured services NOT covered by the Annual Block fee
Class I
$30
Illness and Return to Work Notes
Massage, Physiotherapy and other Allied Health Provider Referrals
Orthotics Form
Letter of Exemption from Jury Duty
Certificate of Freedom from Communicable Disease
Ear syringing**
Missed regular appointment (without advanced notice)
Cosmetic Minor Surgical Procedures (from $30)**
Prescription Renewal
Class II
$50
Travel Insurance Cancellation Form**
Pre-employment Certificate of Fitness**
School and/or Camp Certificate of Fitness
Fitness Club Forms
Pre-operative Form**
Medical Certificate for Employment Insurance Benefits
Life Insurance Death Certificate
Class III
$100
Auto Accident Insurance Forms (if not covered by insurance company)**
Intended Parents Adoption Application Form**
Post-Secondary Education Accessibility Form**
Class IV
$200
Driver’s Medical Form and Physical Exam**
Legal Reports**