Sick Notes And Forms
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| PRIVATE PAY APPOINTMENTS | Price |
|---|---|
| General Visit - In Clinic | $70.00 |
| NP Consult - Telemedicine Clinic Connection | $70.00 |
| NP Consult – Virtual Consultation | $50.00 |
| NP Consult - Follow-Up | $30.00 |
| NP Consult – No Connection Rx Refill | $30.00 |
| Travel Consultation (1 Person) | $70.00 |
| Travel Consultation (2 Person) | $130.00 |
| Travel Consultation (3 Person) | $190.00 |
| Travel Consultation (4 Person) | $250.00 |
| Travel Consultation (5 Person) | $300.00 |
| MD – Virtual Consult | $70.00 |
| MD – In-Person Physician Consult | $90.00 |
| Missed Appointment (Within 24 Hours) | No Refund |
| Specialty Type | Initial Consultation | Follow Up Appointment |
|---|---|---|
| Internal Medicine | $170.00 | $110.00 |
| Urology | $100.00 | $65.00 |
| Pediatrics | $100.00 | $75.00 |
| Missed Specialist Appointments | $50.00 |
| PRIVATE PAY DOCUMENTS | Price |
|---|---|
| Sick Note for School/Work | $30.00 |
| Insurance Note (RMT/Orthotics/Physio/Chiro) | $30.00 |
| Medical Records (Per Request) | $30.00 |
| Insurance Rx Authorization | $50.00 |
| Forms (i.e. University Forms) | $50.00 |
| Travel Cancellation Form | $150.00 |
| EI Disability or Maternity Certificate | $60.00 |
| Immunization Status Form (School/Work) | $50.00 |
| Medical Certificate for EI Compassionate Care Benefits | $80.00 |
| FAF – Company Invoice (Non WSIB) | $80.00 |
| MTO Medical Condition Report | $240.00 |
| Retirement Home Admission Forms | $150.00 |
| Attending Physicians Statement | $200.00 |
| No-Show Appointment Fee | $70.00 |
| Lost Documents | $30.00 |
| PRIVATE PAY TESTS | Price |
|---|---|
| Ear Flush (Per Ear) | $30.00 |
| Urine Pregnancy Test | $15.00 |
| TB Skin Test (1 Step) | $50.00 |
| TB Skin Test (2 Step) | $80.00 |
| TB Skin Test (Total Visit) | $260.00 |
| Injection (Non-OHIP) | $20.00 |
| Type Of Visit | Fee |
|---|---|
| General Consultation | $45.00 |
| Mental Health Treatment/Management | $90.00 |
| Travel Consultation | $70.00 |
| Travel Consultation - 2 people | $100.00 |
| Travel Consultation - Group (Up to 4 people) | $140.00 |
| Form Type | Fee |
|---|---|
| School or Work note (per note) | $20.00 |
| Note for insurance coverage (Massage Therapy, Orthotics, etc.) | $20.00 |
| Travel cancellation form | $40.00 |
| Completion of forms (ex. University forms) | $50.00 |
| Non-WSIB FAF form | $70.00 |
| Attending Physician's Statement (Including disability forms) | $120.00 |
| Photocopy per page | $1.00 |
| Specialty Type | Initial Consultation | Follow Up Appointment |
|---|---|---|
| Internal Medicine | $170.00 | $110.00 |
| Urology | $100.00 | $65.00 |
| Pediatrics | $100.00 | $75.00 |
| Missed Specialist Appointments | $50.00 |
| Procedure Type | Fee |
|---|---|
| Urine pregnancy test | $10.00 |
| Injection for travel purposes (or non-OHIP injections) | $15.00 |
| Ear flush | $25.00 |
| Type Of Visit | Fee |
|---|---|
| General Visit - In Clinic | $70.00 |
| Virtual General Visit | $50.00 |
| Travel Consultation - 1 person | $70.00 |
| Travel Consultation - 2 people (Group/Family) | $100.00 |
| Travel Consultation - 3 people (Group/Family) | $130.00 |
| Travel Consultation - 4 people (Group/Family) | $160.00 |
| Travel Consultation - 5 people (Group/Family) | $180.00 |
| Prescription refills by phone or fax | $30.00 |
| Missed Appointment (Within 24 Hours) | No Refund |
| Specialty Type | Initial Consultation | Follow Up Appointment |
|---|---|---|
| Internal Medicine | $170.00 | $110.00 |
| Urology | $100.00 | $65.00 |
| Pediatrics | $100.00 | $75.00 |
| Missed Specialist Appointments | $50.00 |
| Form Type | Fee |
|---|---|
| School/Work Note (Per Note) | $30.00 |
| Notes for insurance coverage (Massage therapy, Orthotics, etc.) | $30.00 |
| Completion of forms (Price may vary by form) | $50.00 |
| Attending Physician's Statement | $160.00 |
| Travel Cancellation Form | $50.00 |
| Non-WSIB FAF Forms | $70.00 |
| Medical Records (Per Request) - Secure Email or Fax Transmission | $30.00 |
| Procedure Type | Fee |
|---|---|
| Urine Pregnancy Test | $15.00 |
| Injection for Travel Purposes | $15.00 |
| Shots for patient with no OHIP | $15.00 |
| Ear Flushing | $30.00 |
| Type Of Visit | Fee |
|---|---|
| General Consultation | $45.00 |
| Mental Health Treatment/Management | $90.00 |
| Travel Consultation | $70.00 |
| Travel Consultation - 2 people | $100.00 |
| Travel Consultation - Group (Up to 4 people) | $140.00 |
| Form Type | Fee |
|---|---|
| School or Work note (per note) | $20.00 |
| Note for insurance coverage (Massage Therapy, Orthotics, etc.) | $20.00 |
| Travel cancellation form | $40.00 |
| Completion of forms (ex. University forms) | $50.00 |
| Non-WSIB FAF form | $70.00 |
| Attending Physician's Statement (Including disability forms) | $120.00 |
| Photocopy per page | $1.00 |
| Specialty Type | Initial Consultation | Follow Up Appointment |
|---|---|---|
| Internal Medicine | $170.00 | $110.00 |
| Urology | $100.00 | $65.00 |
| Pediatrics | $100.00 | $75.00 |
| Missed Specialist Appointments | $50.00 |
| Procedure Type | Fee |
|---|---|
| Urine pregnancy test | $10.00 |
| Injection for travel purposes (or non-OHIP injections) | $15.00 |
| Ear flush | $25.00 |
MD Connected and TelemedMD have come together to create an improved patient experience and app. It is easier than ever to access a doctor or specialist.
If you are an existing MD Connected patient, we have already created your account for you. You simply need to access it by resetting your password with the “Forgot Password” button using your registered email.
For all new patients, please click the “Log In/Register” button and follow the steps to create a new account.
| Type Of Visit | Fee |
|---|---|
| General Visit - In Clinic | $70.00 |
| Virtual General Visit | $50.00 |
| Travel Consultation - 1 person | $70.00 |
| Travel Consultation - 2 people (Group/Family) | $100.00 |
| Travel Consultation - 3 people (Group/Family) | $130.00 |
| Travel Consultation - 4 people (Group/Family) | $160.00 |
| Travel Consultation - 5 people (Group/Family) | $180.00 |
| Missed Appointment (Within 24 Hours) | No Refund |
| Specialty Type | Initial Consultation | Follow Up Appointment |
|---|---|---|
| Internal Medicine | $170.00 | $110.00 |
| Urology | $100.00 | $65.00 |
| Pediatrics | $100.00 | $75.00 |
| Missed Specialist Appointments | $50.00 |
| Form Type | Fee |
|---|---|
| School/Work Note (Per Note) | $30.00 |
| Notes for insurance coverage (Massage therapy, Orthotics, etc.) | $30.00 |
| Attending Physician's Statement | $160.00 |
| Travel Cancellation Form | $50.00 |
| Non-WSIB FAF Forms | $70.00 |
| Medical Records (Per Request) - Secure Email or Fax Transmission | $30.00 |
| Procedure Type | Fee |
|---|---|
| Urine Pregnancy Test | $15.00 |
| Shots for patient with no OHIP | $15.00 |
| Ear Flushing | $30.00 |
University Health Insurance Plan (UHIP)
1. Have your UHIP Member ID and Policy # available so the MD Connected patient care team can verify your coverage eligibility.
2. Please complete the UHIP claim authorization form provided below and email it to admin@mdconnected.ca.
1. Have your Guard.Me policy card ready so the MD Connected patient care team can verify your coverage eligibility.
2. Please complete the MD Connected authorization form provided below and email it to admin@mdconnected.ca.
1. When using this service, you or your guardian can call Intrepid 24/7 prior to seeking an appointment, and their customer care team will direct you to a contracted clinic.
2. Intrepid 24/7 will fax over the pre-authorization forms. If the forms have not been received by MD Connected you must call the insurer to fax the Verification of Benefits to us.
3. You or your guardian must present your Intrepid 24/7 policy card upon arrival so that our patient care team can verify that you have eligible coverage and sign the authorization forms.
1. You must provide one of the below forms. As long as you have coverage, which can be validated by an MD Connected customer care team member, your visit can proceed.
a. A refugee protection claimant document (RPCD) with photo.
b. An interim federal health program certificate (IFHC).
You can see how this popup was set up in our step-by-step guide: https://wppopupmaker.com/guides/auto-opening-announcement-popups/