Uninsured Services List

UNINSURED SERVICES LIST          February 2016

No Active Healthcare -  Minor visit with exam          

No Active Healthcare -  Major visit with exam

$60.00

$150.00

Medical Records transfer at request of patient (HIA) pages $25.00 + .25/page after first 20 pgs
Sick notes (required after the fact) $30.00
Canada Revenue Disability Tax Form $100.00 (both forms)
Application for guardianship $90.00 - $300.00

Travel Advice (first Visit with doctor)

Subsequent visit (injection) times 2 visits

FAMILY RATE OF FOUR OR MORE

$50.00

$25.00

$150.00

Phone/fax prescription renewals $40.00
AISH form $65.00
Photocopy of patient's chart at request of third party $150.00 + 42 cents/page

Insurance APS reports with copies

Admin fee for postage and handling

$150.00 - $300.00 + 42 cents/page 
$15.00

Third party medicals (sports, daycare, camp) Starting @ $50.00 per page

Cryotherapy of skin lesions not medically indicated or not covered by Alberta Health 

Wart Treatment

1-5 lesions




$20.00 and up

$40.00 and up

 ALL FEES ARE AT THE DISCRETION OF YOUR PHYSICAN. 

YOUR PHYSICIAN WILL CONFIRM WITH THE MANAGER REGARDING ANY WAIVING OF FEES.

Spruce Grove, Alberta, Canada

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