| Common Request | Price |
| Out of Province | $75 |
| Out of Country | $150 |
| * [Quebec Always pay] |
Fee Schedule
PINE CREEK MEDICAL FEE SCHEDULE
| *Doctors Sick Note | $20 |
| *Driver’s Medical Exams | Price |
| Class 1/ Truck Driver’s/Seniors | $100 |
| others Classes | $120 |
| *Disable Parking Authorization | $30 |
| Insurance Form – 3 pgs | $100 |
| Each Page After 3 | $30 |
| *CPP + What CPP Pays | $50 |
| Disablility Benefits | Price |
| Form | $200 |
| Form + Exam | $200 |
| General Insurance Eligibility | Price |
| Form | $100 |
| Form + Exam | $250 |
| Certificate of Fitness [School/Work] | Price |
| Form | $60 |
| Form + Exam | $150 |
| Capacity Assessment form | Price |
| Form | $100 |
| Form + Exam | $500 |
| Attending Physician’s Statement [APS] | Price |
| For Insurance | $250 |
| For Patient | $50/pg or $150> 1pg |
| Pregnancy Leave/Employment Insurance Form | $60 |
| Blue Cross Refugee Claim | Call |
| Valid – No charges/ Valid – Charge | 1-88-618-1880 |
| Blue Cross Special Authorization Form | To Validate |
| Completion of Medical Fitness Forms or Reports AISH Medical Exam+ Form Completion | $177 |
| Pre Employment Medical Exam + Report | $80 |
| Pregnancy Leave/Employment Insurance Form | $80 |
| Medical Report | Price |
| Adoption Assessment | $100 |
| Foster Care Assessment | $100 |
| Motor Vehicle Accident Treatment Plan Alberta Form | $100 |
| Liquid Nitrogen | $30 |
| Transfer of Records | $75 |
| No Show / < 24Hrs. Cancellation | $25 |
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