Forms and Fees

Sick Notes

$20

for parents, school, daycares

No-Show Fee (General Pediatrics Appointment)
No-Show Fee (General Pediatrics Consultation)
No-Show Fee (Allergy Consultation)

$30
$150
$150

Cancellations require at least 24hrs notice. Cancellations less than 24hrs prior to your scheduled appointment, as well as missed appointments, may be subject to a no-show fee.

Medication Administration Forms

$20

CRA Letters

$40

per family

Physical Fitness Form

$30

camp/daycare/school/travel

Physical Fitness Form

$50

employment/military/sports

Primary Caregiver Form

$30

Disability Tax Credit Form

$100

initial form

Disability Tax Credit Form

$50

follow up forms if required

Attending Physician Statement

$150

if not covered by insurer

Insurance Forms

$150

if not covered by insurer

MPI Driver’s Medical Form

$100

Parking Permit Forms

$40

Chart Transfers

– first 20 pages                                                                                         $20
– each subsequent page                                                                     $0.30/page

Physician Letter

– 1/4 page                                                                                                    $20
– 1/2 page                                                                                                    $30
– full page                                                                                                   $40

Other Non-Insured Forms and Reports

– prices will vary by length and complexity of form 
   – <5 min of Physician time                                                             $20
   – 5-15 min of Physician time                                                         $50
   – >15 min of Physician time                                                           $100

Out of Country/No Manitoba Health Card

– Brief Visit (<10 minutes)                                                                  $50
– Medium Visit (>10minutes)                                                          $60
– Full Physical                                                                                          $100
– Vaccination (per immunization)                                                $20

Non-Insured Injection Fee (not including cost of prescription)

 

– Twinrix (Hepatitis A+B) series (3 injections)                      $60
– Twinrix catchup/completion (per injection)                      $20
– Typhoid (one injection)                                                                   $30

Ear Piercing

– Complete Piercing Package* with topical numbing       $100
– Complete Piercing Package* without numbing                $90

*Complete Piercing Package includes: sterile earrings, piercing procedure, after care solution and instructions

– Replacement safety backing for earrings                            $5
– Additional sterile earrings                                                            $50