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Filling Out a Medical Form

Annual (Block) Fee

    This information sheet is to inform you of changes in our office policy. For your information, OHIP does not pay for all services that you request from your doctor(s). These services include prescription renewals by phone or fax, insurance forms, sick notes, and others listed on the next page. Services that OHIP does not pay for are called "non-insured or uninsured services" .In order to maintain the financial viability of our practice and ensure prompt service, it is necessary for our practice to charge for these services.

    You have the option to pay for each service individually at the time it is provided, or choose to pay an all-inclusive annual fee. Every effort has been made to account for most of the commonly requested services in this information sheet for inclusion in the Annual Fee.

    The fees contained in the list below are based on the Ontario Medical Association's suggested fees as found in the 2016 edition of the OMA Physician's Guide to Uninsured Services. The Annual Fee for individuals is $150.00 and for families is $325.00

    All uninsured services must be paid in full when rendered. You will receive a receipt for tax purposes following payment. Please note that our office accepts cheques, credit card and Interac payments (

Please acknowledge receipt and acceptance of the above office policy by signing and returning the downloadable form, immediately below, by either fax 416-962-2526, mail, email or in person to our office.




Vera Fried MD, Saila Kuruganty MD, Cathy McNally MD, Katie Killorn MD, Poonam Batra MD,

Jenny Ng MD, Tanya Stone MD

Download, print and complete this form  to opt in or out of the block fee program. To pay online visit the payment page and email the form to

Price List

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