Acton Medical & Urgent Care
10 Eastern Avenue
Acton, ON L7J 0A5
Tel: 519-853-4449 Fax: 519-853-5242
ALERTS
Acton Medical and Urgent Care:
Family Doctor's Office, Walk-In Clinic and Dynacare Lab
will be closed: October 9th
Driver's Medical - Ministry of Transportation exams can be booked at our office: $80
Uninsured Services
What are "non-OHIP" covered services or "uninsured services"?
Non-OHIP covered services/Uninsured Services are those services provided to patients that are not covered by the Ontario Health Insurance Plan (OHIP) which is determined by the Ministry. This includes services such as but not limited to: notes, forms, letters and certificates; referrals for physio therapy, massage therapy and orthotics; ear flushing and cosmetic procedures, wart removal/skin tag removal; as well as splints, tensor bandages and if your health card is not valid on the day of your appointment etc..
Why am I being charged for these services?
OHIP pays physicians for most medical services delivered to patients. Services not covered by OHIP are called uninsured services. Your physician will request a payment from you for those services. It is the patient's responsibility to pay for uninsured services.
How are the uninsured fee rates determined?
When fees are charged for uninsured services, they are based on the Ontario Medical Association's suggested fees as found in the most current edition of the OMA Physician's Guide to Third Party and Other Uninsured Services.
What forms of payment are accepted for uninsured services?
Fees are payable by either cash or Interac e-Transfer.
(The office staff can provide the specific email address for Interac e-Transfer)
For more information about uninsured services, feel free to visit the Ontario Ministry of Health website
Fees for Uninsured Services
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Payment options: fees are payable by cash or e-transfer and are due at the time of the service. The office will provide you with the specific email address for the e-transfer at time of payment.
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The listed fees are a minimum fee, which may increase based on complexity of document or document format. The doctors reserve the right to make adjustments to the fees listed below at any time without notice.
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The fee for any document that is not specifically listed below will be determined by the doctor upon their review of the document and their assessment of what is involved in the document completion.
Uninsured Fees
Expired or Invalid Health Cards or No Health Card
Basic Documents
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$ 20.00 Sick notes (includes notes for return to work/school and free of communicable disease)
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$ 20.00 Documentation for Massage Therapy, Physiotherapy, Orthotics, Acupuncture, Chiropractic, Back Brace, or Compression Stockings for Insurance coverage
Completion of Form/Documents that may be associated with patient physicals
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$ 25.00 School/Camp
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$ 25.00 Admission to day-care, preschool, university
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$ 45.00 Pre-employment certification of Fitness
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$ 45.00 Certification of Fitness for Fitness Facility
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$ 45.00 Abilities form for Workplace
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$ 20.00 Medical Clearance for Dental Procedure
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$ 40.00 Pre-Op Form (No longer covered by OHIP)
Completion of licensing Form/Documents:
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$ 80.00 Ontario Ministry of Transportation Driver's Medical Form/Physical
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$ 150.00 Driver's Medical Form/Physical (ANY driver's medical form that is not 'Ministry of Transportation Ontario' Form)
Other Form/Documents:
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$ 83.00 CRA Disability Tax Credit Form - Paper Format
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$ 150.00 CRA Disability Tax Credit Form - Digital Format
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$ 45.00 Employment Insurance Sickness Benefits - Medical Certificate
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$ 55.00 Children’s Aid Society (CAS) Application for Prospective Foster Parent
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$ 20.00 CPP for Specialist
Life, Health and Accident Benefits Insurance Form/Documents:
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$ 160.00 Attending Physician's Statement (APS)
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$ 160.00 Disability
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$ 145.00 Treatment Plan
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$ 140.00 Determination of Catastrophic Impairment
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$ 160.00 Treatment Confirmation
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$ 110.00 System-Specific or Disease Specific Questionnaire
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$ 130.00 System-Specific Examination
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$ 260.00 Insurance Medical Examination
Miscellaneous Form/Documents:
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$ 55.00 Medical Certificate for Employment Insurance Compassionate Care Benefits
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$ 45.00 Life Insurance Death Certificate
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$ 80.00 Travel Cancellation Form
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$ 160.00 Citizen and Immigration Canada Medical Report for Immigration
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$ 105.00 Request for Medical Information re: Applicants to the Armed Forces
Procedures
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$ 50.00 PAP not covered by OHIP (additional processing fee is billed directly by Dynacare Laboratory)
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$ 40.00 - 200.00 Skin Tag/Lesion Removal
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$ 40.00 - 100.00 Wart/Corn Removal (wart removal on feet may be referred to a dermatologist)
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$ 40.00 Ear Flushing/Wax Removal.....for 3 days prior to this appointment patients must administer 3 drops of mineral oil into the ears 5 times daily.
Medical Supplies
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$ 30.00 Arm Splint
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$ 20.00 Suture Glue
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$ 5.00 Finger Splint
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$ 5.00 Tensor Bandage
Miscellaneous
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$ 30.00 Copying/Transmission of Medical Record(s) (first 20 pages), $0.25 per page thereafter
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$ 75.00 Travel Consultation for 1 patient
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$ 125.00 Travel Consultation for 2 patients (in same family), $ 30.00 for each additional family member
(Travel consultation fee includes the initial consultation and follow-up appointments to administer injection(s).
The travel consultation fee does NOT included the cost of purchasing the injection(s) at a Pharmacy)
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$ 60.00 TB 1 Step (2 in office appointments are required, these are time specific appointments)
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$ 90.00 TB 2 Step (4 in office appointments are required, these are time specific appointments)
A VALID Health Card is required for ALL visits at Acton Medical and Urgent Care.
If you DONT have a VALID Health Card a cash fee is required for ALL visits - See the fees listed below
The Type of assessment that will be charged is determined by the physician which is based on OHIP guidelines
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$ 60 Minor Assessment
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$ 90 - 95 Intermediate Assessment
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$ 210 - 215 Major Assessment