Third Party Requests (Forms & Medicals)
Examples of third party requests:
Disability forms . Tax credit applications . Missed work notes
Return to work notes . Driver medicals . School or Sport Medicals
Some of these requests require physician assessment and some do not.
Ask staff to help you determine which is appropriate for your request.
ALL forms require information that requires physician and staff time to provide.
Fees for these services are most often the responsibility of the patient, not the requesting body.
The physician can estimate the fee associated with your form and advise you for pre-approval before processing.
Check your form carefully to ensure that you have filled out any areas that are required of the patient and provide your signature. This is your “authorization for release of information”. Your physician cannot process your form without this permission.
When providing your appointment for third party medical, staff will advise of the anticipated fee for this service.
Common Report fees:
. Driver Medical $100.00
. Pilot Medical $130.00 (Commercial)
$160.00 (Private)
. Missed work note $15.00
. Return to work note $15.00
. Insurance form $25.00 and up, (dependent on the volume of required information)
. Photocopying $30 (first 20 pages) + $0.25 per page thereafter
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