Fees for Uninsured Services
Our clinic closely follows the Doctor’s of BC annual uninsured fee schedule. Forms
Brief General Certificate/Travel/Time Off School or Work 30
Government EI Form 40
SPARC or HandyDart Form 40
Special Authority Form - when requested by third party insurer 80
Insurance Company Short Form - Disability/Travel/Time off 170
Insurance Company Long Form - Disability/Travel/Time off 220
Income Tax Disability - Initial Short Form 160
Income Tax Disability - Secondary Long Form 220
Nursing Home & Assisted Living Registration Forms 170
Reports/Letters
Medical Advice by Letter 170
Medical Letter - Support Letter/Immigration/Insurance Company/Leave or Off Work 190
Medical - Legal Letter 395
Medical - Legal Report 1179
Medical - Legal Opinion 1973
Examinations
Sport Team/Camp School Exam + Form 80
Work/School Entrance Exam + Form 100
Industrial First Aid or WCB First Aid Exam + Form 180
Insurance and Industrial Examination, including CPP, pilots and air traffic controllers 230
Driver’s License Exam + Form 230
Diabetic Driver Report - stand alone (no Driver’s Medical Examination Report) 230
Employer's Occupational Fitness Assessment Form 180
CPP/MOT/Insurance Co. APS Forms + Physical 220
Procedures
Cosmetic Cryotherapy with Liquid Nitrogen 60
Excision of Skin Tags (no sutures) Cosmetic - Max 3 per visit 180
Excision of Mole or Scar on Body (sutured) Cosmetic 240
Excision of Mole on Face (sutured) Cosmetic 300
Private Flu Shot (not covered by MSP) 35
Uninsured Urine Pregnancy Test 15
Uninsured Urinalysis 10
Others
MSP Ineligible/Private Pay Appointments 170
Missed Appointment Charge 35
Transfer of Records 50
Physician Review of Records for Medical/Legal Purposes (per 15 min) 111
Transfer of Records - photocopying - per page (first 10) 2
Transfer of Records - photocopying - per page (subsequent pages) 0.3