New uninsured services fees effective may 1, 2024

Mapleton Health Centre
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    • Home
    • About Us
      • Team Members
      • Mission, Vision, Values
      • Equality & Diversity
    • Services
      • Uninsured Services
      • Appointments
      • After-Hours
      • Online Booking
    • News
    • Contact Us
      • Contact Us
      • Job Opportunities
      • Physician Recruitment
      • New Patients
    • Resources
      • Policies & Procedures
      • FAQ
      • Resources
      • Forms and Consents
      • Vaccination Information
      • COVID-19 Information
      • Ocean Support
Mapleton Health Centre

Signed in as:

filler@godaddy.com

  • Home
  • About Us
    • Team Members
    • Mission, Vision, Values
    • Equality & Diversity
  • Services
    • Uninsured Services
    • Appointments
    • After-Hours
    • Online Booking
  • News
  • Contact Us
    • Contact Us
    • Job Opportunities
    • Physician Recruitment
    • New Patients
  • Resources
    • Policies & Procedures
    • FAQ
    • Resources
    • Forms and Consents
    • Vaccination Information
    • COVID-19 Information
    • Ocean Support

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Forms & Consents

About Mapleton Health Centre

Forms & Consents

The healthcare providers at the Mapleton Health Centre comply with the CPSO’s policy outlining the timely completion of all medical forms. A physician or healthcare provider at MHC has up to 45 days to complete a third-party medical form or up to 60 days to complete the form if a medical exam is required to facilitate the completion of the requested form. 


To help facilitate a timely return of your forms please note the following:


  • All portions of your forms that are required to be completed by you are done and signed prior to giving them to your provider.
  •  Adding specific dates (i.e., first day off work, first day you saw your provider, dates of procedures, surgeries, etc.) will allow your provider to complete your forms faster. 
  • Some forms that may involve extensive chart review and/or examination, will require an in-person appointment, unless otherwise discussed with your healthcare provider. You will be advised of this. 
  • Please note that most medical forms are not covered by OHIP. A detailed list of uninsured services and associated fees can be found here . 
  • Forms will not be released without payment.

Forms

New Patient Intake Form (pdf)

Download

Allergy Patient Case History Form (pdf)

Download

Allergy Injection Consent Form (pdf)

Download

Separated and Divorced Parent Policy -Signature Form (pdf)

Download

Driver's Medical Report Form (pdf)

Download

Medication to Avoid Prior to Allergy Testing (pdf)

Download

Consents

(2022) Consent to Disclose Personal Health Info (pdf)

Download

(2022) MHC Release Form (pdf)

Download

(2022) MHC Request to Access Personal Health Records (pdf)

Download

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