Additional Fees:
Fees not covered by MSP include the following:
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Forms/Notes: Fees:
*Work/School time off/Doctors Certificate $50.00
*Physiotherapy/Massage therapy, Brief letter/note $50.00
*SPARC Form/Handidart/General Certificates $50.00
*Disability/travel/time off (short form) $173.00
Disability/travel/time off (long form) $225.00
*Income Tax Disability Form $173.00
*Attending Physicians Statement (Insurance Form) $173.00
*Functional Abilities Form / Work Abilities $65.00
Nutritional Supplement Application $25.00
Employer’s Occupational Fitness Assessment $197.00
Special Authority Form – when requested by 3rd party insurer $87.00
Long Term Care Registration / Administration $177.00
Reports / Letters:
Medical Certification of Death $50.00
Medical Advice by Letter $173.00
Medical Leave or off work letter $197.00
Examination:
General Insurance Examination or Physical $193.00
School/Camp Physical Fitness exam (Including Certificate) $86.00
*Driver’s License Full Exam (Yellow Stripe) $238.00
*Driver’s License Medical Exam (Blue Stripe) $163.00
Additional Diabetic Driver Report (DMER) $140.00
Other:
*Transfer of Records $50.00
Copies of Results/Chart Material per Page (first four) * $5.00
Copies of Results/Chart Material per Page (after first four) * $1.00
Re-referral charge for missed consultation appointments $25.00
Missed Appointment Charge $70.00
Treatments:
Liquid Nitrogen other than plantar warts (material costs) $5.00
Liquid Nitrogen prepaid four treatments $15.00
Excision Mole (cosmetic) - Facial $230.00
Excision Mole (cosmetic) - non-Facial $155.00
Excision/biopsy (cosmetic) - no suture $110.00
***We also offer TB Testing please speak with receptionist to book an appointment –
TB testing Fee - $45.00***
