Uninsured Services | Guelph Internal Medicine Clinic

Fees for uninsured services

Missed Appointments

Appointments missed without at least one business day notice, unless there are valid extenuating circumstances (at our discretion).

Comprehensive Consultation

$310

An Internal Medicine Consultation of 75 minutes or more

Initial Consultation

$164

Initial Internal Medicine Consultation

First Follow-up

$81

First follow-up appointment after initial or comprehensive consultation

Second or Further Follow-up

$61

Second or further follow-up appointment after initial or comprehensive consultation

Dietitian or Psycotherapy Appointment

$185

Any dietitian or psychotherapy appointment

Forms and Statements

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Prior Authorizations Forms

$25.25 to $125 +

Required by some private insurers to cover specific drugs or treatments.

Based on a time to complete and complexity.

Attending Physician Statement for Insurance

$160 +

Fee can increase depending on complexity and time required.

System-Specific or Disease Specific Questionnaire

$160 +

Fee can increase depending on complexity and time required.

Clarification Report

$160 +

Fee can increase depending on complexity and time required.

Prescriptions (Refills, Orthotics, Massage, etc)

$25.25

Medication refills outside of a visit, orthotics, massage, etc.

Short-tem disability / Fitness to work forms

$50

Fee can increase depending on complexity and time required.

Back to work note, sick note or daycare note

$25.25

Fee can increase depending on complexity and time required.

Travel Insurance Cancellation

$160

Fee can increase depending on complexity and time required.

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