Uninsured Services | Rainbow Falls Medical Clinic

Uninsured Services

Some services are not covered by the Alberta Health Care Insurance Plan. Patients are directly responsible for the associated fees, however, they may also be billed to a private insurer or government agencies. Our staff and physicians will discuss the pricing and payment options prior to completing any forms or services. The following prices have been set in accordance with the Alberta Medical Association’s Uninsured Services Fee Guide.

Forms

Appointment Fees

Medical-Legal Services

Clinical Services

Form Type	Price
Assured Income for the Severely Handicapped (AISH) Forms:
Medical Examination	$84.35 - mental health $138.03 - physical examination
Form Completion	$67
Attending Physician's Statement *Based on physician's time taken to complete the form	$50 per 15 minutes (up to 60 minutes) $40 per 15 minutes (beyond 60 minutes)
Insurance Forms/Disability Benefit Report *Based on physician's time taken to complete the form	$50 per 15 minutes (up to 60 minutes) $40 per 15 minutes (beyond 60 minutes)
Disability Eligibility/Insurance - Form and Exam	$250
Doctor’s Note/Sick Note	$25
Capacity Assessment Report	$400+
Driver’s Medical - Form and Exam	$100 (registered patients) $150 (walk-in patients)
Employment Insurance Form	$70
Pregnancy Leave Form	$70
Pre-Employment - Form and Exam	$200
Senior’s Residence Medical Report	$80
Blue Cross Special Authorization Form	$55
Disabled Parking Authorization Form	$35 (seniors 75+) $50 (<75)
Canada Revenue Agency (CRA) Disability Tax Credit Form	$120
Canada Pension Plan (CPP) Forms:
Initial Assessment	$125
Follow-Up/Re-Assessment	$50
Narrative Report	1 page - $75; 2 page - $150; 3+ pages - $225;
Note of Fitness - Form Only	$60
Note of Fitness - Form and Exam	$135
Veteran’s Affairs - Form and/or Exam	$130
Transfer of Medical Charts *Please note that we require a minimum of a 50% deposit in order to transfer medical records, as per the Health Information Act	$50

Fee Type	Price
No Show - General Appointment (2nd in a calendar year)	$50
No Show - General Appointment (3rd+ in a calendar year)	$100
No Show - Physical Exam	$150
No Show - Mental Health Appointment	$120

Service Type	Price
Review, Report, and/or Interpretation of File and/or Patient Attended at the Request of Lawyer	$525/hour
Report on Patient Attended, with Opinion (May Include Further Examination)	$700/hour
Chart Request by Lawyer (Consent Provided by Patient)	$100

Service Type	Price
Out-of-Country	$120
Out-of-Province - Single Issue	$60
Out of Province - Multi-Issue	$100
Physical Exam - No Health Card	$150
Physical Exam + PAP Smear - No Health Card	$180
Liquid Nitrogen Treatment	$10/appointment
Pregnancy Test	$5
Mole Excision	$90
Nebulizer Treatment	$20
Uninsured Vaccine Injection (Twinrix, Shingrix, Hepatitis A/B)	$10/injection
Travel Consult	$50