Each of the forms and services listed below are subject to a fee that must be paid by the patient in full PRIOR to seeing the physician for your appointment. These fees are per AMA guidelines and may be adjusted depending on the particular situation. As per CPSA guidelines physicians have 30 days to complete, after receiving the forms request.

Insurance forms and reports

– Disability Benefit Reports

– Attending Physician’s Statement

– CRA Disability Tax Credit Form

– General Insurance Eligibility Forms

– AISH

School or work forms and reports

– Sick Note

– Return to Work

– School Requested Forms & Reports

– Certificate of Fitness (Summer Camp, School, Travel, etc.)

– Pre-Employment/Periodical Health Exam (Uninsured)

– E.I./Pregnancy Leave Forms

Medical fitness forms and reports

– Driver’s Medical (any class)

– Aviation Medical

– Disabled Parking Placard

– Seniors Residence Medical Reports (Lodge, Manor, etc)

– Child Welfare Forms (Adoption/Foster Care)

Office procedures

– Surgical excision of warts/moles (cosmetic)

– Liquid Nitrogen (includes all treatments for affected area)

– Other Non-surgical (cosmetic) procedures vary

– BOTOX varies

**BOTOX for chronic headaches & hyperhidrosis is partially covered**

Photocopies and charts

– If Requested by Insurance Companies/Third Parties

– Patient Request (as per Alberta HIA regulations)

– File Transfer to Another Clinic

Other fees

– Travel Advice (fee is dependent on time and information required)

– Phone/Fax Prescription Requests (only done in extenuating circumstances)

– Missed Appointments (after 2 ‘no-shows’ in a 12 month period)

– Uninsured Office Visit

– Uninsured Complete Visit