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
  • No credit or debit on site
  • Cash or cheque only
  • All documents must be pad for prior to releasing
Insurance Forms
Attending Physician Statement - Insurance
$185 - $375
Blue Cross Special Authorization Forms
$55
Disability Benefit Report - AISH
$245
Proof of Death Physician Statement
$100
Third Party Requested Letters on Patients
$240 - $480
General
All Unspecified Forms
$300/hour

Calculated per 5 minutes

Canada Pension Plan disability
$120
Circumcision
$250
CRA Disability Tax Credit
$120
Disabled Parking Form (placard)
$50
Driver's Medical
$150
Employment Insurance
$100
File Transfer & Copy
$25 + 25c/copy
Fitness Medicals - Summer Camp, Sports, Travel
$100
Missed Appointment (No-Show) to be paid prior to making another appointment
$60
Non-Resident Consultation Fee
$50 - $100
Note of Fitness
$100
Pre-employment Medical Exam & Report
$150
Senior's Residence Medical Report
$55
Sick Note
$35