Non insured services

Non insured services

WORK & SCHOOL

School forms or medical certificate

No Examination (Report Only) $ 50

With Examination $ 90—135

Fitness certificate for summer camp, daycare, travel etc /form only $ 55

With examination $145

Pre-employment medical and report $160—350

Sick note by Doctor $ 25

Insurance

APS Form $185-$375

Insurance physical/ Form $275-$480

General insurance form $275-$480

Disability

Disability form without exam – form only $95-$155

Disability parking placard form $60—$105

Disability benefit report with exam $145-$230

Driver’s Medical

Drivers medical examination and form $160-$295

Leave of Absence/ Maternity Leave

Form for temporary leave UIC, Pregnancy Leave, etc without exam $60—$100

Blue Cross special authorization $55

SENIOR >74.5years/ans

Applications and other forms seniors’ residence medical report

Form only  $55-105

Exam and Form  $150-275

VETERAN’S AFFAIRS

Exam and or form completion  $65-135

Applications and other forms

Capacity assessment and report $133.05

Co-deciding guardianship both guardianship and trusteeship Max. $500

Medical Reference form on perspective adoptive/foster parents/guardians
with examination $213.05

Without examination $80.00

Handicapped Children services (letter) $55-80

Report

Report or letter/per 15 min.

Without examination $45 per 15 min

Administrative services

Medical record transfer Minimum $75

Paper version $ 30.00 includes 25 pages then add 0.25 per additional copy

CD version $35.00

Preparation time (per 15 min) $45.00

Posting fee $15

Photocopy – page $0.25