Uninsured Services Price List

Forms

Sick Note

$25

Doctor's Certification Note

$25

Includes notes for massage therapy, physiotherapy, chiropractic therapy, orthotics, compression stockings, etc.

Disability Insurance Claims Form

$80

Modified Duties/ Company Work Form

$80

Parking Permit

$50

Hand-Transit

$50

CRA Disability Tax Credit Form

$100

MPI Alcohol/ Drug Reporting Form

$50

RCMP/WPG Police Medical Health Form

$100

Camp/School Form

$100

Travel Cancellation Form

$50

School Immunization Form

$60

NIHB Form

$30

Proof Of Death Form

$50

Missed Appointments

Please note, after the first no show, you will not be charged but will be made aware of the cancellation policy and associated fees. You will be charged for all subsequent no-shows, and these fees must be paid prior to booking the next appointment. Three or more no shows may result in termination from the practice.

Missed Regular Appointment

$60

We require a minimum of 24-hour notice of cancellation of an appointment. Cancellations are easiest done online via the patient portal link on our website, www.familycaremed.ca. As well, you can cancel an appointment directly from the notification sent to your SMS and/or e-mail address when you initially booked your appointment. Additionally, you may cancel in person, via telephone or fax.

Missed Physical Exam or Specialty Appointment

$120

Uninsured Services Price List

Physical Exams & Office Visits Not Covered by MHSC

Work Physical Exam & Form

Adoption Physical Exam & Form

Sport Physical Exam & Form

Private Surgery Pre-Op Exam & Form

MPI Driver's Physical Exam & Form

Travel Health Office Visit

Patients Without Valid MHSC Coverage

Initial Visit

Follow-Up Visit

Forms

Sick Note

Doctor's Certification Note

Disability Insurance Claims Form

Modified Duties/ Company Work Form

Parking Permit

Hand-Transit

CRA Disability Tax Credit Form

MPI Alcohol/ Drug Reporting Form

RCMP/WPG Police Medical Health Form

Camp/School Form

Travel Cancellation Form

School Immunization Form

NIHB Form

Proof Of Death Form

Mantoux

TB One-Step (Injection Only, Form Extra)

TB Two-Step (Injection Only, Form Extra)

Immunizations Not Covered by MHSC

Hepatitis A (Injection Only)

Hepatitis B (Injection Only)

Twinrix (Combined Hepatitis A/B Injection Only)

HPV Vaccine (Injection Only)

Shingles Vaccine Zostavax (Injection Only)

Shingles Vaccine Shingrix (Injection Only)

Pneumonia Vaccine Prevnar (Injection Only)

All other injections not covered by MHSC

Miscellaneous

Private EKG

Transfer of Chart

Bloodwork for Third Party

Missed Appointments

Missed Regular Appointment

Missed Physical Exam or Specialty Appointment