Price Guide

Services listed below are not covered by OHIP or provincial health insurance. Our fees follow Ontario Medical Association suggested rates and are benchmarked against local clinics to ensure they are fair.

All fees are in Canadian dollars (CAD). Prices may change. For the most current rate, call us or check in at the clinic before your visit.

We accept all Canadian-issued cards, most international cards, Apple Pay, Google Pay, Samsung Pay, and cash (exact change appreciated — we do not carry change).

How to request a form / note

  1. Book an in-person appointment online — all forms and sick notes require an in person visit.
  2. Bring the form with you, or email it ahead to info@midtown.clinic.
  3. Payment is due at the visit — credit, debit, tap, or cash.
  4. Some forms take a week or longer; we'll contact you when it's ready. One revision is included; additional revisions are billed per OMA guidelines.

Am I covered?

I have a valid Ontario health card
Medically necessary visits are covered by OHIP at no cost. The fees on this page apply only to uninsured services (notes, forms, cosmetic procedures, etc.).
I forgot my card / my card is expired
A temporary card works fine. If your card is fully expired, you'll pay the private rate (consultation $100) and we can sort things out once your card is renewed.
I have an out-of-province health card
We accept out-of-province coverage, excluding Quebec. Quebec-insured patients are invoiced directly and given a receipt to claim back home.
I'm a newcomer / I have IFH / I have no coverage
We accept IFH (Interim Federal Health) coverage. Patients without any coverage pay the private rate — consultation $100, follow-up for the same issue within 2 weeks $60 — with a receipt for private insurance claims.

Uninsured & Out-of-Province Visits

Consultation — no valid OHIP or Canadian provincial health card Excluding Quebec. A physician letter will be provided for insurance reimbursement submission
$100
Follow-up for same issue within 2 weeks
$60
TB Skin Test — administration (uninsured) Excludes school, Ministry of Health, LTC admission, or medically necessary purposes (OHIP covered)
$110
TB Skin Test — reading only (uninsured)
$50
TB Skin Test — per visit (insured)
$30

General Notes & Forms

Back-to-work note, sick note, VIF, or daycare note
$25
MTO Medical Report (Driver's Physical)
$180

Federal Forms

Disability Tax Credit Certificate — T2201 (CRA)
$180
EI Compassionate Care Benefits Medical Certificate — INS-5216
$75
EI Sickness Benefits Medical Certificate — INS-5140
$50

Insurance & Disability Forms

Attending Physician Statement (Life/Disability Insurance Application)
$180
Insurance Certificates
Contact clinic
OCF-3 — Disability Certificate (car accident insurance)
$256
OCF-18 Treatment Plan
$272
OCF-19 Application for Determination of Catastrophic Impairment
$151
OCF-23 Treatment Confirmation
$256
Short-Term Disability / Fitness to Work / Functional Abilities Form (Non-WSIB)
$50
Prior Authorization for Private Insurance Drug Coverage For Ozempic/Mounjaro: non-diabetics are typically declined coverage by insurers
$50

School & Workplace

Proof of Immunization Forms
$50

Procedures — Liquid Nitrogen

Skin tag removal For more than 3 skin tags, review pricing with physician
$40 / tag
Wart treatment Excludes genital warts, plantar (feet) warts, and skin cancers/pre-cancers (OHIP covered). Multiple sessions typically required.
$30 / session

Procedures — Other

Dorsal wrist ganglion cyst Incision, drainage of cyst, and injection with corticosteroid. Corticosteroid fee separate
$100

Miscellaneous

CAS Medical Report (Adoption / Foster / Kinship / Customary Care)
$120
Uninsured prescriptions (refills, orthotics, massage, etc.) — if sole purpose of visit
$25
Prescription refill without a visit Fee applies only if physician determines an appointment is needed and patient declines
$40 (if refused appt)
Medical records release — to patient or physician (digital copy) First two (2) copies can be provided free of charge to the patient. Beyond that, there will be a $30 fee for the digital copy provided. The price for the print copy is to be discussed with the clinic.
Waived
Medical records release — to a third party
Contact clinic

Missed-Appointment Fees

Fees charged when an appointment is missed without notice.

Family practice visit Repeated no-shows may result in restriction to your ability to book online
Waived
Specialist consultation (Men's Health, Metabolic Health)
Physician discretion
Pap test with Dr. Vanderkooy
$50

Questions about pricing?

Call us at (226) 686-0119 or drop in — we're happy to confirm costs before your visit.

Book Appointment → (226) 686-0119
Form Completion Policy

We are committed to working collaboratively with patients to complete forms and sick notes in a way that reflects their needs. However, please note the following:

  • Outcomes are not guaranteed. Payment for a form (such as a long-term disability application) does not ensure a specific result.
  • Clinical independence is maintained. Patients may not dictate the final clinical content of a physician's documentation.
  • One revision may be considered in the listed price for each form.
  • Additional revisions will be billed in accordance with the OMA guidelines for uninsured services, based on the physician's hourly rate. Payment is required upfront, with the physician invoicing for anticipated time in advance.
  • No refunds can be issued once work on a form has begun.
  • An in-person appointment is required for all forms.

Thank you for your understanding.

Prices follow Ontario Medical Association suggested fees and are benchmarked against local clinic rates. All prices subject to change — confirm at time of service.

Fee guide last updated July 2026.