Gloucester Family Health Centre
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Fees for Uninsured Services
(Services not covered by OHIP)

Assessments

Minor Assessment (for Non-OHIP Patients or not covered by OHIP)                 ..................................................................................................................................................................       $68.19
Intermediate Assessment (for Non-OHIP Patients or not covered by OHIP)      ..................................................................................................................................................................    $108.99
General Assessment (for Non-OHIP Patients or not covered by OHIP)               ..................................................................................................................................................................    $250.95
Annual Complete Physical Examination/General Physical Examination (GPE) (for OHIP Patients, not covered by OHIP)  .........................................................................................    $186.30
Travel Consultation and Vaccine Administration (Per person per trip - Max. 3 countries) (Vaccine cost not included)       ..........................................................................................      $98.33


Procedures

​One Step TB Test (for employment or volunteering purposes)                             ..................................................................................................................................................................      $67.28
Two Step TB Test (for employment or volunteering purposes)                            ..................................................................................................................................................................       $77.63
Uninsured vaccine injection (per injection)                                                              ..................................................................................................................................................................      $31.05
Ear Syringing (per ear)                                                                                                 ..................................................................................................................................................................      $41.40
Pregnancy Test                                                                                                              ..................................................................................................................................................................      $15.00
Covid Test                                                                                                                      ..................................................................................................................................................................      $11.85
Skin Tag Removal (up to 3 tags)                                                                                 ..................................................................................................................................................................      $50.00


Forms, Letters and Notes

Referral Note for massage therapy, orthotics, back support, stockings etc.          ..................................................................................................................................................................      $19.67
Completion of documentation/forms for physicals for schools, camps, pre-school, daycare, university/educational institutions  ...............................................................................      $34.93
Completion of documentation/forms for physicals for pre-employment certification of fitness/fitness clubs or hospital/nursing home employee  .................................................      $46.32
Sick notes (includes return to work/school notes), Certificate of freedom from communicable disease  ..........................................................................................................................     $31.05
Drivers’ medical examination (form only)                                                                ..................................................................................................................................................................      $72.45
Drivers’ medical examination (Includes medical assessment, vision assessment and form)    .............................................................................................................................................    $323.40
Children’s Aid Society (CAS) application for prospective foster parent (Examination and form)    ..................................................................................................................................    $238.05
Pension buyback                                                                                                           .......................................................................................................................................    Case based (Min $340)
Clarification Report/Full Narrative Report                                                              ...........................................................................................................................................................    $455.00/hr
CRA Disability Tax Credit Certificate (form T2201)                                               ...........................................................................................................................................................    Case based
Life insurance death certificate                                                                                   ...........................................................................................................................................................    Case based

Civil aviation medical examination report 26-0010E (001004)                             ...........................................................................................................................................................    Case based
Attending Physician Statement                                                                                   ...........................................................................................................................................................    Case based
Any other form (not listed above)                                                                              ...........................................................................................................................................................    Case based


Administrative Fees

Printing/Transmission of Results/Reports (per result/report)                             ...................................................................................................................................................................       $7.00
Release of Medical Records (Copying/printing/scanning)                                     .......................................................................................     $31.05 (first 20 pages), thereafter $0.26 per page
Release of Medical Records (Electronic transfer)                                                     ..................................................................................................................................................................      $41.40
Physician review of records for release of medical records                                     ...............................................................................................................     $45 per 15 mins, after first 15 mins
Immunization record replacement                                                                              ..................................................................................................................................................................     $41.40
No-show/missed regular appointment                                                                       ..................................................................................................................................................................     $72.45
No-show/missed annual health examination appointment                                     ..................................................................................................................................................................      $93.15
Same Day Cancellation (less than 24 hours)                                                               .................................................................................................................................................................      $31.05
Invalid Health Card (Refundable in 30 days on presenting Valid HC)                    .................................................................................................................................................................     $70.00


Unremunerated Report Forms

Application for Accessible Parking Permit                                                                 .........................................................................................................................................................      No charge
Accessible Transit Eligibility Application forms                                                       .........................................................................................................................................................      No charge
Children’s Aid Society Forms (on behalf of a child)                                                 ..........................................................................................................................................................      No charge
Canadian Passport Application                                                                                   ..........................................................................................................................................................      No charge
Ministry of Health Forms (e.g., Assistive Devices, etc.)                                          ..........................................................................................................................................................      No charge


Payment Modes

- Credit/Debit Card
- E-transfer - [email protected] {Mention the patient’s name, physician’s name, and reason in the message}
- Cash


​ Here to Download the Comprehensive List of Uninsured Services and Fees


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  • Privacy Policy