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Missed Appointments: 48 hours notice is required for cancelling appointments in order to avoid the missed appointment fee.
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Missed Appointments (15 minutes)
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$80.00
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Missed Appointments (20 minutes to 1 hour)
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$200.00
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Missed Appointments (1 hour 15 minutes to 3 hours)
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$300.00
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Paperwork (Letters, Forms): Autism Exists Diagnosis Clinic is focused on the provision of diagnosis assessments for Autism Only. Please see your family physician for routine form completion. In extenuating circumstances, costs for various paperwork is as follows:
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AISH FORM: we do not offer AISH support at present. Please see your family doctor for completing the AISH Medical
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AISH Support Letter: (extenuating circumstances would need to apply. Please see your family physician for AISH Medical Reports) (usually 4-6 pages). Fee is $50.00 per page
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$50.00/page
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Alberta Works Income Supports: Form (extenuating circumstances would need to apply. Please see your family physician for AB Works Income Supports)
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$200.00
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Alberta Works Income Supports: Letter confirming Medically Unfit for Work(simple)
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$20.00
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Blue Cross Special Authorization Form: (extenuating circumstances would need to apply. Please see your family physician for Medication Authorization forms)
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$80.00
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Blue Cross Special Authorization Form: (extenuating circumstances would need to apply. Please see your family physician for Medication Authorization forms)
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$80.00
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Disability Application Form (i.e. Short Term, Long Term, Permanent): (extenuating circumstances would need to apply. Please see your family physician for Disability Application forms). Per 15 minutes direct time on form.
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$60.00/15 min
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Disabled Parking Placard Application Form: (extenuating circumstances would need to apply. Please see your family physician for Parking Placard Applications).
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$60.00
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Disability Tax Credit Form: (extenuating circumstances would need to apply. Please see your family physician for Disability Tax Credit Application forms). Please note that there is a separate fee for the initial application form and the subsequent Additional information letter, if applicable.
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Initial Form
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$150
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Additional Information Form: Per page of form. (typically 3-4 pages without cover/signature page)
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$60.00 /page
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Employment Insurance: Form (extenuating circumstances would need to apply. Please see your family physician for Employment Insurance Forms) (per page)
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$60.00
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Private Examinations: Extenuating circumstances would need to apply. Please see your family physician for Private Medical Exams
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Driver's Physical Examination and Application Form
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$180.00
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Medico-legal work, physician time: (extenuating circumstances would need to apply. We do not offer medicolegal or expert opinions as part of our medical care. ) (Cost for direct and indirect time for written opinion, forms and related costs, per 15 minutes)
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$200.00/15min
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Medico-legal physician court time: (extenuating circumstances would need to apply. We do not offer medicolegal or expert opinions as part of our medical care. ) (per 15 minutes. Charged for time related to travel to and from court and waiting time)
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$250.00/15min
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Medico-legal work, staff time: (extenuating circumstances would need to apply. We do not offer medicolegal or expert opinions as part of our medical care. ) (per 15 minutes)
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$50.00/15min
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Third Party Medical Exam (i.e. Work, University forms): (extenuating circumstances would need to apply. Please see your family physician for Private Medical Exams. Also note that many third-party exams require specific qualifications for the examining physician. You are responsible for determining necessary qualifications.) (per page)
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$100.00/page
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Uninsured Appointments: This medical practice serves Alberta residents living in the Calgary Zone who are insured under Alberta Health Services. In extenuating circumstances, direct service fees may become applicable. In such situations, the fees are as follows:
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Uninsured Medical Visit up to 15 minutes
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$150.00
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Uninsured Medical Visit per additional 10 minutes
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$65.00
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Uninsured Mental Health Visit per 15 minutes
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$100.00
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Uninsured Home Visit, initial 15 minutes
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$280.00
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Uninsured Home Visit, per additional 10 minutes
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$65.00
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Miscellaneous:
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Photocopying (per page)
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$1.00
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Telephone/Fax Prescription Refill: (extenuating circumstances only. Please see your family doctor for prescription refills. Also note that this fee applies for messages from pharmacies seeking refills on your behalf.)
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$50.00/medication
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Transfer of Records: (base fee covers first 25 pages)
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$25.00+0.25/page
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