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Uninsured Services
Some of the services we provide are not covered by OHIP.
These fees must be paid prior to redeeming services .
Fees are subject to change
Forms/Certificates (Examples)
Back to Work/Sick Note/School Note
$ 25.00
Modified Duty Note
$ 40.00
TB Skin Test for Employment (visit and note)
$ 40.00
One Step
TB Skin Test for Employment (visit and note)
$ 50.00
Two Step
Short Term Disability Form
$ 35.00
Revenue Canada, Federal Disability Tax Credit
$ 85.00
Attending Physician Statement
$ 164.00
Disability Form – Private Insurance
$ 45.00
EI/Disability/Maternity Certificate (NS2019)
$ 25.00
Medical Certificate - Specialists
Varies
Medical Certificate - Standard
$ 25.00
Photocopies 1-5 pages
$2.00
Photocopies - each additional page
$1.00
Other Forms
Contact Us
Clinical Procedures:
Liquid Nitrogen Treatment
1 lesion/treatment
$ 25.00
2 lesion/treatment
$ 25.00
3 or more lesion/treatment
$ 30.00+
Other Procedures
Skin Lesion Removal (benign) per lesion
$ 125.00 - $175.00
Consultations and Visits:
Private consultations requested by non-OHIP card holders or third parties.
Third Party /Annual Physical (additional fees for forms vary)
$171.00 - $300.00
Third Party includes employers, insurance companies, summer camps, institutions, MOT medical forms
(Not the standard MOT physical as listed above)
General Assessment A003/Driver’s Medical Exam & Form
$145.00
Intermediate Assessment A007
$ 90.00
Minor Assessment A001
$ 60.00
No Show Fee
$ 50.00
Regular Visit: Basic Fee (Including Quebec insured patients)
$ 90.00
Specialist No Show Fee (Varies depending on specialist)
$ 100.00
Completion of forms may take up to 10 business days
Transfer of Records:
Letters/Non-specified Forms
Varies
Copy and Transfer of Medical Records
$45.00
Other
Letters for Therapy or Medical Devices
$25.00
Missed Appointment without cancellation (24 hours)
$ 40.00 - $60.00
NSF Cheque
$ 25.00
Travel Clinic
Individual Consult
$ 75.00
Couple Consult
$ 80.00
Family Consult - Couple Rate + $25/additional person Vaccines
Travel Medicine Injection (Not including visit)
$ 15.00
Including other follow-up injections (HPV)
Flu Shot for Private Patients
$22.00
Vaccines
Additional costs
Travel Immunization Injection Fee/injection
$ 10.00
(if not purchased at CFFM Travel Clinic)
TB Test for travel: Sole reason for visit
$ 40.00
Includes injection, follow-up & results certificate
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Patient Rights and Responsibilities
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Magnolia Health Center
537 Frederick Street, Kitchener, Ontario N2B 2A7, Canada
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