FEES FOR UNINSURED SERVICES
(These are all covered by the Annual Fee or the $10.00 per visit)
The following fees will be charged to the parent on an individual basis if you choose
Option #1. Payment is expected when the service is given, but no service will be denied if payment cannot be paid immediately.
1. Telephone advice from office staff (per 10 minutes or part thereof) $25.00
2. Prescription Renewals (by phone- long distance charges extra) $20.00
3. Forms (e.g., daycare, school, camp, insurance, gov't., etc.)
a) form only $30.00
b) Doctor's signature only $20.00
(Note: If a physical exam is required, this will be extra-see below)
4. Letters requested for third parties (e.g., sick notes, insurance) $30.00
5. Transfer of medical record $40.00
7. Photocopying and faxing on behalf of patient $1.00 per pg.
8. Long distance charges cost
SERVICES NOT COVERED BY ANNUAL FEE
1. Missed appointments for counselling without prior notification $80.00
2. Missed appointments for physical exams etc. $80.00
3. Missed appointments for iillness $50.00 and up
(without notification) $50.00
3. Physical examination requested by third party $75.00
4. Formal medical legal or insurance letters $75.00 - $150.00 pp
