Uninsured Services

The following list accounts for the most commonly requested uninsured services. If your service is not listed below, please ask your family physician or the billing department. All uninsured services must be paid in full when complete. A receipt will be provided upon settlement of your account.

Fees: $75.00

Forms can be obtained from the place of employment (for short term disability or maternity leave). Otherwise they can be obtained from Service Canada.

There is a one page form to be completed by the physician. In addition, there is an online form to be completed by the patient. Assistance can be found at Service Canada for completing the form.

The physician’s form can be dropped off at the ELFHT reception. The patient will be contacted once it is completed. The process can take several weeks.

Fees: $25.00 (for EI Sick Benefit only. No fee for Maternity Leave Form)

Forms can be obtained from the place of employment (for compassionate care) or from Service Canada. There is a difference between Compassionate Care and Caregiver forms, in the number of weeks leave, and the percentage of pay received.

There is a one page form to be completed by the physician. In addition, there is an online form to be completed by the caregiver. Assistance can be found at Service Canada for completing the form.

The physician’s form can be dropped off at the ELFHT reception. The patient will be contacted once it is completed. The process can take several weeks.

The disability tax credit forms can be obtained from Service Canada.

Disability tax credits are for people with specified disabilities to decrease the amount of payable taxes. Examples of relevant disabilities are those that affect mobility, sight, hearing, mental health, or those that require life sustaining therapy (such as oxygen treatments). The specific qualifications are listed on the forms.

Forms can be dropped off at the ELFHT reception. The patient will be contacted once they are completed. The process can take several weeks.

Fees: $35.00

These forms are provided by the insurance company or place of employment. Each form will specify the information that needs to be provided.

Forms can be dropped off at the ELFHT reception. The patient will be contacted once they are completed. The process can take several weeks.

Fees: $35.00

For the transfer of a medical file to a new physician, the patient will sign a release of information form and have the new physician send it to the ELFHT.

To obtain the medical file for patient viewing, the patient will sign a release of information form and request a paper or disk copy of their records. It is simpler and faster to request a specific part of the records, instead of the entire file.

Patients can call the clinic and speak to the receptionists to obtain their records. The process can occasionally take several weeks time. The patient will be called when the records are ready to be picked up.

Fees: $30.00 pages 1-20 $0.25 per page thereafter $45.00 max fee

For the transfer of a medical record to a new health professional, the patient will sign a release of information form and have the health professional send it to the ELFHT.

To obtain the medical record for patient viewing, the patient will sign a release of information form and request a paper or disk copy of their records. It is simpler and faster to request a specific part of the records, instead of the entire medical file.

Patients can call the clinic and speak to the receptionists to obtain their records. The process can occasionally take several weeks time. The patient will be called when the records are ready to be picked up.

Fees: $1.00 per page (20 pages or less)

Loan or credit protection forms for medical leave can be obtained from the patient’s insurance company or bank.

Some physicians request an appointment with the patient to complete the forms.

Forms can be dropped off at the ELFHT reception. The patient will be contacted once they are completed. The process can take several weeks.

Fees: $35.00

Fees: $35.00

Fees: $25.00

Fees: $10.00

Fees: $35.00