Patient Forms

Need a form completed or a doctor’s note?

If you have insurance forms, Canada Revenue forms, Ministry of Transportation forms, or require a doctor’s note, please review the information below before submitting your request.

Important Form Information

Uninsured Services

Please refer to the charges for uninsured services not covered by OHIP below.

Completion Timeline

Physicians have up to 30 days to complete forms.

Final Fee

Upon completion, your doctor’s administrative assistant will contact you with the final fee.

Payment & Reimbursement Notes

  • Payment options include cash or card. Upon payment, a receipt will be provided.
  • Some fees may be eligible for reimbursement by specific insurance carriers. NEOMO Medical does not maintain a list for these.
  • Please consult your insurance provider or the entity requiring the completed paperwork to determine whether you are eligible for fee reimbursement.
Submit a Form

Uninsured Services

Charges for Uninsured Services

These services are not covered by OHIP. Fees are supported by Ontario Medical Association guidelines.

Completion of Form Physicals

Schools/camps, admissions to day-care, preschool, university, or any other educational institutions, OSAP/NOSM

$33.75

Pre-employment certification of fitness / fitness clubs, hospital / nursing home employees

$44.75
Other

Back-to-work notes, sick notes, daycare note free of communicable disease

$25.00

Letter for massage therapy, orthotics, back support, stockings, etc.

$30.00

Missed appointment: PAP / general appointment

$50.00

Missed annual health check

$50.00 / $75.00

Missed IUD / minor procedure

$100.00

Invalid OHIP health card / no health card — non-refundable

$40.00
Licensing

Ministry of Transportation drivers physical / medical

$125.00

Driver’s medical exam report — form only

$70.00

Ministry of Transportation licence assessment / reinstatement

$50.00

Auto Ability Form

$30.00
No Charge

Application for accessible parking permit / transit forms for disabled patients

No Charge

PR card forms / request for birth certificate form / Canadian passport application

No Charge

Children’s Aid Society form on behalf of a child / Ministry of Health and Long-Term Care forms

No Charge
Insurance Certificates

OCF-3 Disability Certificate

$256.00

Drug acceptance form / prior authorization form

$40.00

Attending Physician Statement — APS

$160.00

Travel cancellation insurance form

$75.00

Life insurance death certificate — always check with MD before charging

Hourly Rate

EI medical certificate / compassionate care benefits for Employment Insurance

$40.00

System-specific or disease-specific questionnaire

$114.00

Insurance medical examination

Hourly Rate

Full narrative / clarification report

$114.00

CPP Disability Medical Report Form

$45 to patient / $85 to Service Canada

CPP Narrative Medical Report

$150 Service Canada

Revenue Canada Federal Disability Tax Credit

$100.00
Other Forms

ODSP Ontario Disability

Bill MOH

Functional Abilities Form — non-WSIB

$50.00

Children’s Aid Society application for prospective foster parent

$246.00

Medical certificate for Employment Insurance sickness benefits

$30.00
Chart Requests

Insurance company chart request

$50 cover letter / $50 first 20 pages / $0.50 per page

Electronic transfer / chart request requested by patient

$50 cover letter / $35 transfer