Medical Clinic Ajax | Family Doctor Ajax

Uninsured Services

In line with our commitment to offering you timely and adequate medical care, we would like to inform you that certain services requested from your doctor may not be deemed medically necessary by the Ontario Health Insurance Plan (OHIP) and, as a result, are not covered by OHIP. These services, which include insurance forms, legal letters, sick notes, and cosmetic medical procedures, are referred to as “non-insured or uninsured services.” BayWest Medical Centre will charge for uninsured services in accordance with the fees guidelines set by the Ontario Medical Association (OMA) and the College of Physicians and Surgeons of Ontario (CPSO).

The following list accounts for most requested uninsured services. However, if the service you request is not on the list below, please communicate it to the clinic’s staff or your doctor and you will be given further clarification.

All uninsured services must be paid in full when rendered. A receipt will be provided upon settlement of the account. Please be advised that, currently, our office only accepts cash or interac transfer for these services.

Medical Exams and Procedures

Service	Price
ALL RATES ARE SUBJECT TO INCREASE
MEDICAL EXAMS
General Assessment or Physical (A003 equivalent)	$275
Intermediate Assessment (A007 equivalent)	$120
Minor Assessment (A001 equivalent)	$80
Child Annual/Camp Physical	$50
Driver’s medical examination (form included)	$190
Major Visit/Adult Physical	$90
Physical Examination required by third party	$150
Travel Advice	$90
FORMS/NOTES
Attending Physician’s Statement (APS)	$175
Back to work/Sick note	$35
Certificate of Medical Status	$40
Children’s Aid Society Application for Prospective Foster Parent	$250
Clarification Certificate	OMA Guidelines
CPP Disability Medical Report Form	$150
Day Care Note (Free of Communicable Disease)	$35
Driver’s Medical Exam (MOT, FLRC80 Form + Physical)	$190
Driver’s Medical Exam (MOT, FLRC80 Form Completion only)	$100
EI Disability	$100
Employment Insurance – Maternity Certificate	$65
Fitness Club Form	$60
Full Narrative Report	OMA Guidelines
General Questionnaire	$50
Letter for exclusion from jury duty	$125
Lawyer’s Letters	OMA Guidelines
Letter on Behalf of Patient	$75 – $350
Life Insurance Death Certificate	$150
Lost Prescriptions / Referral Notes	$25
Massage Therapy, Orthotics, Physio, Compressing Stockings, etc.	$35
Medical Certificate for EI Compassionate Care Benefits	$110
Medical Report-Canadian Immigrants	$125
Ontario Accessible Parking Permit (For People with Disability)	$0
Other Insurance Forms	OMA Guidelines
Pre-Employment Certificate of Fitness	$65
Prescription by Fax / Phone	$25
Private Insurance Sickness and Disability – Long Term	$300
Private Insurance Sickness and Disability – Short Term	$125
Revenue Canada/Federal Disability Tax Credit	$150
School, Camp Physical (Form only)	$65
Sick Note	$35
System or Disease Specific Questionnaire	$150
Travel Cancellation Form	$80
Treatment Plan Form	$125
School or Work forms to verify Immunization Status	$140
Retirement Home admission forms	$225
Special Authorization for drug coverage form (non-ODB, private insurance)	$125
Guarantor documents (i.e., for passports, birth certificates)	$120
Canada AutoAbility physicians form (P2220)	$65
Pregnancy confirmation note for immigration purposes	$65
Other simple forms not otherwise specified	$50 / 5-minute increment
PROCEDURES
Excision & Suture of Cysts (first lesion)	$350
- Each additional	$180
PRP per session	$425
Circumcision Disclaimer : There maybe be increase in charge depending on baby’s size and age	$425
IUD insertion (when no insurance coverage)	$125
Synvisc injection	$70
IMMUNIZATIONS
Injections needed for Travel	$25
TB Mantoux One Step Test	$75
TB Mantoux Two Step Test	$95
OFFICE/ADMINISTRATIVE
Missed Appointment without 24hr notice	$70
Missed Physical Examination	$100
TRANSFER OF MEDICAL RECORDS
First 20 pages	$30
Each Page After 20	$0.25
Electronic Transfer Of Records	$30
Prescription Renewal by Fax (when Appropriate)	$25
DERM PROCEDURES
ALL RATES ARE LESION BASED AND SUBJECT TO INCREASE
Excision moles/lesions	$240
Cyst excision	$400
Seborrheic Keratosis	$75 (cryotherapy), $230 (excision)
Skin Tags Removal, thin based (1-4)	$75
Skin Tags Removal, thin based (5-10)	$150
Skin tags, broad based	$230
Non-genital or Palmer Warts scraping and cryotherapy	$75
Fulguration (face)	$230
Sebaceous hyperplasia (face cryotherapy)	$175
Sebaceous hyperplasia (face desiccation)	$280
Hypertrophic scar (cryotherapy)	$120
Hypertrophic scar (intralesional steroid)	$170
Alopecia areata (intralesional steroid)	$170
Lipoma	$350

Patient Resources

Uninsured Services

The following list accounts for most requested uninsured services. However, if the service you request is not on the list below, please communicate it to the clinic’s staff or your doctor and you will be given further clarification.

All uninsured services must be paid in full when rendered. A receipt will be provided upon settlement of the account. Please be advised that, currently, our office only accepts cash or interac transfer for these services.

Medical Exams and Procedures

Address

Medical Clinic

Pharmacy

Medical Clinic Hours

Pharmacy Hours