Chargeable Services

(fees subject to change without notice)

Missed Appointment (without 24 hours notice)

$30.00

Missed Physical (without 24 hours notice)

$60.00

Expired OHIP Card - General Visit

$33.00

Physical (Drivers)/By 3rd party request

$75.00/$125.00

Pre-employment Certificate of Fitness

$20.00-$35.00

Applications/Forms (Insurance, Disability, etc)

$75.00

WSIB Form 8 HPR/FAF - Paper/E-Version

$65.00/$75.00

Applications/Forms plus physical examination

$125.00

TB test (for employment) 1 Step/2 Steps

$40.00/$60.00

Life Insurance death certificate

$45.00

CPP Disability medical report form

$85.00

Insurance: #OCF-3 disability certificate

$135.00

Doctor Note (Back to work/Sick/Day Care)
$10.00-$20.00
Forms for insurance coverage of massage therapy, compression stocking, orthotics etc.

$20.00

Maternity Leave, employment, sickness benefit Forms

$30.00

Pregnancy Test

$10.00

IUD Insertion

$45.00

Charts: $1/page first 30 pages then $0.25/page thereafter

Up to $30.00 + $0.25 per page

Photocopying

$1.00 per page

Skin procedure - mole, lesion, skin tag removal

$20.00 each

Pre-travelling counseling + Rx

$40.00

Travel related vaccine (hepA, hepB, Twinrix, Typhoid, Menactra, etc)

$10.00

Form for compassionate care benefits, trip cancellation

$40.00

CRA Disability Tax Credit

$25.00

Payments for the above services are to be made payable to:
Petawawa Centennial Family Health Centre