Walk in 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)	$250
Intermediate Assessment (A007 equivalent)	$100
Minor Assessment (A001 equivalent)	$70
Child Annual/Camp Physical	$35
Driver’s medical examination (form included)	$150
Major Visit/Adult Physical	$70
Physical Examination required by third party	$120
Travel Advice	$70
FORMS/NOTES
Attending Physician’s Statement (APS)	$150
Back to work/Sick note	$30
Certificate of Medical Status	$30
Children’s Aid Society Application for Prospective Foster Parent	$230
Clarification Certificate	OMA Guidelines
CPP Disability Medical Report Form	$115
Day Care Note (Free of Communicable Disease)	$30
Driver’s Medical Exam (MOT, FLRC80 Form + Physical)	$150
Driver’s Medical Exam (MOT, FLRC80 Form Completion only)	$75
EI Disability	$80
Employment Insurance – Maternity Certificate	$50
Fitness Club Form	$50
Full Narrative Report	OMA Guidelines
General Questionnaire	$30
Letter for exclusion from jury duty	$100
Lawyer’s Letters	OMA Guidelines
Letter on Behalf of Patient	$50 – $300
Life Insurance Death Certificate	$120
Lost Prescriptions / Referral Notes	$20
Massage Therapy, Orthotics, Physio, Compressing Stockings, etc.	$30
Medical Certificate for EI Compassionate Care Benefits	$85
Medical Report-Canadian Immigrants	$100
Ontario Accessible Parking Permit (For People with Disability)	$0
Other Insurance Forms	OMA Guidelines
Pre-Employment Certificate of Fitness	$50
Prescription by Fax / Phone	$20
Private Insurance Sickness and Disability – Long Term	$250
Private Insurance Sickness and Disability – Short Term	$100
Revenue Canada/Federal Disability Tax Credit	$100
School, Camp Physical (Form only)	$50
Sick Note	$30
System or Disease Specific Questionnaire	$120
Travel Cancellation Form	$60
Treatment Plan Form	$100
School or Work forms to verify Immunization Status	$115
Retirement Home admission forms	$190
Special Authorization for drug coverage form (non-ODB, private insurance)	$100
Guarantor documents (i.e., for passports, birth certificates)	$100
Canada AutoAbility physicians form (P2220)	$50
Pregnancy confirmation note for immigration purposes	$50
Other simple forms not otherwise specified	$40 / 5-minute increment
PROCEDURES
Excision & Suture of Cysts (first lesion)	$300
- Each additional	$150
PRP per session	$400
Circumcision Disclaimer : There maybe be increase in charge depending on baby’s size and age	$375
IUD insertion (when no insurance coverage)	$100
Synvisc injection	$50
IMMUNIZATIONS
Injections needed for Travel	$20
TB Mantoux One Step Test	$50
TB Mantoux Two Step Test	$70
OFFICE/ADMINISTRATIVE
Missed Appointment without 24hr notice	$50
Missed Physical Examination	$80
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)	$20
DERM PROCEDURES
ALL RATES ARE LESION BASED AND SUBJECT TO INCREASE
Excision moles/lesions	$200
Cyst excision	$350
Seborrheic Keratosis	$60 (cryotherapy), $200 (excision)
Skin Tags Removal, thin based (1-4)	$60
Skin Tags Removal, thin based (5-10)	$120
Skin tags, broad based	$200
Non-genital or Plantar Wart scraping and cryotherapy	$60
Fulguration (face)	$200
Sebaceous hyperplasia (face cryotherapy)	$150
Sebaceous hyperplasia (face desiccation)	$250
Hypertrophic scar (cryotherapy)	$100
Hypertrophic scar (intralesional steroid)	$150
Alopecia areata (intralesional steroid)	$150
Lipoma	$300

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