Uninsured Services

Not all services are covered by Alberta Health Care. The cost of these additional services are at the discretion of the individual physician and may be adjusted depending on the complexity of the form, procedure or time involved.

Please discuss charges for all form completion with your family physician BEFORE proceeding with the paperwork
Insurance Forms and Reports
  • Some Blue Cross forms
  • Disability Benefit Reports
  • Attending Physician’s Statement (please check the form, it will state on it whether the patient is responsible for payment)
  • Canada Revenue Agency Disability Tax Credit Form
  • General Insurance Eligibility Forms
  • Alberta Insurance for the Severely Handicapped (AISH)
Completion of School and 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
Completion of Other Medical Fitness Forms and Reports
  • Driver’s Medical (any class for age <74.5 years)
  • Aviation Medical
  • Disabled Parking Placard
  • Seniors Residence Medical Reports (Lodge, Manor, etc.)
  • Child Welfare Forms (Adoption/Foster Care)
Other Fees
  • Travel Advice (depends on how much time/information is required)
  • Missed Appointments (to avoid being charged, please call in to cancel at least one hour before your appointment time)
  • Transfer of Chart
  • Appointment Visit Reports (for income tax purposes)
  • Copies of Medical Charts
  • Uninsured Office Visit
  • Uninsured Complete Visit
Fees for Uninsured Services
  • We accept credit and debit cards, as well as cash and cheques
  • All documents must be paid for prior to releasing
Insurance Forms
Attending Physician Statement - Insurance
$185 - $375
Blue Cross Special Authorization Forms
Disability Benefit Report - AISH
Proof of Death Physician Statement
Third Party Requested Letters on Patients
$240 - $480
All Unspecified Forms

Calculated per 5 minutes

Canada Pension Plan disability
CRA Disability Tax Credit
Disabled Parking Form (placard)
Driver's Medical
Employment Insurance
File Transfer & Copy
$25 + 25c/copy
Fitness Medicals - Summer Camp, Sports, Travel
Missed Appointment (No-Show) to be paid prior to making another appointment
Non-Resident Consultation Fee
$50 - $100
Note of Fitness
Pre-employment Medical Exam & Report
Senior's Residence Medical Report
Sick Note