Dr. V. Dawson & Dr. R. Furtado
Family Physicians
Diane Rogalski
Registered Psychotherapist
(Qualifying)
phone: 705-220-1710
fax: 705-717-7560
Uninsured Fees - Not Covered by OHIP
payable before services rendered
we offer a 3% discount for paying by cash or debit card, please ask at time of payment
Missed Appointments Without 48 Hour Notice
Missed Appointment (phone/in person) ..... $41.24
Missed Physical/Half Hour Appointment ..... $82.47
Individuals Without OHIP Coverage
Patient Phone Appointment ..... $61.86
Patient In-Person Appointment ..... $82.47
Forms and Document Completion
Canada Pension Plan Application ..... $103.09
Disability Tax Credit Form ..... $61.86
Driver’s Medical/Physical ..... $103.09
E.I. Medical Certificate Form ..... $41.24
Note for Medical Leave from Employment ..... $41.24
Pre-Employment Health Assessment ..... $41.24
School/Daycare Health Assessment Form ..... $41.24
Sick Note for School/Work ..... $20.62
Work Forms/Attending Physician Statement ..... $164.95
Medical note for Physiotherapy, massage, chiro. ..... $20.62
Dr. Dawson’s Services
Botox – per unit ..... $10.31
Filler – 1 syringe ..... $639.18
Cosmetic Skin Tag/Lesion ..... $61.86
Subsequent Skin Tag/Lesion ..... $10.31
Dr. Furtado’s Services
Monovisc – 1 injection ..... $412.37
Patient Records
Copying of Chart (1-20 pages) ..... $41.24
Additional Pages (after 20th page) ..... $0.26/page
Transfer of records (up to 20 pages – mailed or faxed) ..... $61.86
All Other Uninsured Services
Flat Fee, billed in 15-minute increments ..... $329.00/hr
Ear Syringing ..... $41.24/ear